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PubMedDate not supplied

Pain interventions with children: a meta-analysis of research.

A meta-analysis of 27 studies on pain management interventions with children was conducted using two decades of research reported in five disciplines. One-fifth of these studies were in the nursing literature and 78% were published since 1979. Two complementary methods of calculating the effectiveness of pain management interventions were used for each of three outcome categories. Fisher's Combined test procedure was used to combine the results of the independent studies, to determine if a significant relationship existed between pain management programs and children's response. An overall effect size (r) was also calculated. Significant relationships of small magnitude were found between pain management interventions and child's response for behavioral (r = .41, chi 2 = 181.97, p less than .0001), self-report (r = .34, chi 2 = 122.06, p less than .0001), and physiologic (r = .30, chi 2 = 88.29, p less than .0001) measures.

Child↗

PubMed2026

Reassessment of the effect of oral l-arginine on blood pressure: A systematic review and meta-analysis based on ambulatory blood pressure monitoring.

OBJECTIVE: This meta-analysis aimed to evaluate the effect of oral l-arginine supplementation on ambulatory blood pressure (ABP). METHODS: A systematic search of PubMed, Cochrane Library, Embase, and Web of Science databases was conducted from their inception through March 1, 2026. Randomized controlled trials (RCTs) assessing the effects of oral l-arginine intervention were included. Outcome measures included 24-h systolic blood pressure (24h SBP), 24-h diastolic blood pressure (24h DBP), daytime systolic blood pressure (dSBP), daytime diastolic blood pressure (dDBP), nighttime systolic blood pressure (nSBP), and nighttime diastolic blood pressure (nDBP). Meta-analysis was performed using Stata 17.0. The weighted mean difference (WMD) was used as the effect size, and the results were pooled with 95% confidence intervals (CIs). RESULTS: A total of 5 RCTs comprising 202 participants were included. Meta-analysis results demonstrated that oral l-arginine significantly reduced 24h SBP (WMD = -4.23 mmHg, 95% CI [-5.87, -2.58]; P < 0.01) and 24h DBP (WMD = -3.04 mmHg, 95% CI [-4.48, -1.59]; P < 0.01). Significant reductions were also observed for dSBP (WMD = -4.16 mmHg, 95% CI [-5.90, -2.41]; P < 0.01) and dDBP (WMD = -4.25 mmHg, 95% CI [-5.85, -2.66]; P < 0.01). Furthermore, oral l-arginine significantly lowered nSBP (WMD = -5.70 mmHg, 95% CI [-7.81, -3.58]; P < 0.01) and nDBP (WMD = -4.18 mmHg, 95% CI [-6.27, -2.09]; P < 0.01). CONCLUSION: Oral l-arginine supplementation significantly reduces ABP. However, the number of included studies was limited, and further validation through additional relevant research is warranted.

Arginine↗

PubMed1997

Resistance training in children and youth: a meta-analysis.

This research used meta-analysis to examine the effect of resistance training on children and youth. Studies investigating the effects of various forms of resistance training in participants of ages less than 18 years were analyzed. Effects sizes (ES) were calculated by gender, age group (boys ages > or = 16 years and girls ages > or = 14 years were defined as older), training (isokinetic, isometric, isotonic), and design type (pretest-posttest or experimental-control). Similar ESs were obtained for older and younger children; isotonic methods demonstrated larger ESs than isometric or isokinetic. Larger ESs were obtained in studies with cross-sectional (experimental-control) than pre-post designs. Resistance training appears to enhance muscular endurance and strength in children and youth. The magnitude of the effect appears to be a function of gender, training method, and experimental design.

Adolescent↗

PubMed2006

[The efficacy of artificial liver support system treatment on hepatic failure in China: a meta-analysis].

OBJECTIVE: Conducting a meta-analysis to evaluate the efficacy of artificial liver support system (ALSS) in the treatment of hepatic failure in China. METHODS: Clinical trials comparing ALSS vs. routine medical treatment of hepatic failure in China were identified from computer-based literature. The pooled odds ratio and 95% confidence interval (CI) of prognostic indicators, such as survival rate and clinical improvement rate at discharge, were used to measure the magnitude of the efficacy. RESULTS: Ten trials including 1030 patients were identified. The odds ratio (95% CI) of survivorship or improvement of ALSS over routine medical treatment in early, intermediate and advanced stages of hepatic failure were 3.72 (2.03-6.83), 2.79 (2.88-4.14) and 1.85 (0.96-3.56) respectively. CONCLUSION: ALSS treatment is more effective in early and intermediate stages of hepatic failure than routine medical treatment, but not in its advanced stage.

Humans↗

PubMed2002

Utility of the WHO neurobehavioral core test battery in Chinese workers-a meta-analysis.

We performed a meta-analysis to determine the most sensitive subtests of the WHO Neurobehavioral Core Test Battery (NCTB) when administered to Chinese workers. Extensive Chinese Biological Medical Database and MEDLINE searches, review of cited references, and discussion with other investigators were undertaken. Data were extracted from 39 eligible studies; the summary effects (effect sizes) were calculated using a fixed-effect model. Various exposure agents showed different sensitivities to the seven subtests of NCTB. For mercury-exposure, the Benton Visual Retention was the most sensitive subtest, with an effect size (95% CI) of 6.0 (4.4-7.6). For lead-exposure, the most sensitive subtests were the Pursuit Aiming II and Profile of Mood States, with effect sizes (95% CI) of 11.3 (8.3-14.3) and 10.6 (7.5-13.7), respectively. For organic solvents-exposure, Digit Span, Pursuit Aiming II, and Digit Symbol were the most sensitive subtests, with effect sizes (95- CI) of 4.7 (3.3-6.1), 4.6 (3.1-6.1), and 4.1 (2.7-5.5), respectively.

China↗

PubMed2006

Evaluation of the formocresol versus mineral trioxide aggregate primary molar pulpotomy: a meta-analysis.

OBJECTIVE: To apply meta-analysis to compare the clinical and radiographic effects of mineral trioxide aggregate (MTA) with formocresol (FC) when used as wound dressing for pulpotomy of primary molars. STUDY DESIGN: The study list was obtained by searching MEDLINE, The Cochrane Library, EMBASE, and SCI. Only those papers that met the inclusion criteria were analyzed. RESULTS: Six studies met the inclusion criteria. There was significant difference between the success rates of FC- and MTA-treated pulpotomized primary molars (P < .05). Clinical assessments and radiographic findings of the MTA versus FC pulpotomy suggested that MTA was superior to FC in pulpotomy resulting in a lower failure rate, with the RR (Relative Risk) being 0.32 (95% confidence interval [CI] 0.11 to 0.90) and 0.31 (95% CI 0.13 to 0.74), respectively. Internal root resorption happened less in the MTA group with RR 0.29, 95% CI 0.11 to 0.77. CONCLUSION: MTA induces less undesirable responses and might be FC's suitable replacement.

Aluminum Compounds↗

PubMed1996

The outcome of absence epilepsy: a meta-analysis.

We performed a meta-analysis of studies on absence epilepsy (AE) to ascertain whether the outcome of this well-defined type of epilepsy can be stated unequivocally. Using the Index Medicus and Medline CD+, we identified 1,619 publications. After applying the criteria of the International League against Epilepsy (ILAE) for AE, 26 publications on 23 study cohorts with a total of 2,303 patients were included. Remission rates ranged from 0.21 to 0.89; they differed substantially due to heterogeneity between the studies in inclusion criteria, methods, follow-up length, and outcome definitions. One half of the patients developed generalized tonic-clonic seizures (TCS) in the course of the disease. The proportion seizure free was 0.78 for patients with absence seizures (AS) only, and 0.35 for those who developed TCS. The outcome of AE may be worse than previously stated due to the considerable proportion of patients developing TCS in the course of their disease. Early prediction of outcome in patients who present with AS cannot be provided with certainty.

Adolescent↗

PubMed1991

Using meta-analysis in psychiatric research.

Meta-analysis is a technique for summarizing the results of many studies which can allow reviewers in a particular field to arrive at a synthesis of the various findings in a more objective manner than relying on expert opinion and combine the results of these studies to arrive at an overall estimate of the magnitude of the effect of a treatment, to determine if the evidence favours its effectiveness. The technique consists of determining an effect size or odds ratio for each study and combining them, taking into account the fact that studies with large samples should exert more influence than those with small samples. However, the procedure is not mechanical. The reviewer must make a series of decisions regarding the studies to be included or excluded, the weight to place on the methodological rigour of the trials, the results from each study to be used, how to handle differences in the magnitude of the results across studies, how to derive the best overall estimate of the effect across studies, and how to determine the precision of that estimate. Each of these decisions can affect both the quality of the review and the nature of the findings.

Humans↗

PubMed1998

Conditional logistic regression with sandwich estimators: application to a meta-analysis.

Motivated by a meta-analysis of animal experiments on the effect of dietary fat and total caloric intake on mammary tumorigenesis, we explore the use of sandwich estimators of variance with conditional logistic regression. Classical conditional logistic regression assumes that the parameters are fixed effects across all clusters, while the sandwich estimator gives appropriate inferences for either fixed effects or random effects. However, inference using the standard Wald test with the sandwich estimator requires that each parameter is estimated using information from a large number of clusters. Since our example violates this condition, we introduce two modifications to the standard Wald test. First, we reduce the bias of the empirical variance estimator (the middle of the sandwich) by using standardized residuals. Second, we approximately account for the variance of these estimators by using the t-distribution instead of the normal distribution, where the degrees of freedom are estimated using Satterthwaite's approximation. Through simulations, we show that these sandwich estimators perform almost as well as classical estimators when the true effects are fixed and much better than the classical estimators when the true effects are random. We achieve simulated nominal coverage for these sandwich estimators even when some parameters are estimated from a small number of clusters.

Animals↗

PubMed2005

Pediatric spinal cord injury without radiographic abnormality: a meta-analysis.

UNLABELLED: Using a meta-analysis, we identified 392 published cases of patients recently diagnosed with spinal cord injuries without radiographic abnormalities (SCIWORA) and studied the epidemiologic, pathophysiologic, clinical, and radiologic data. To describe those at risk for this uncommon syndrome, mainly pediatric patients (90% of the cases) who sustain serious trauma in car accidents, serious falls, sports injuries, or child abuse, we analyzed the reported information in the literature. Magnetic resonance imaging scans may indicate neural (hemorrhages, edema, or both) or extraneural (disc protrusions, extradural hematomas) injuries, and the location and type of the injury. Every patient having magnetic resonance imaging scans had either intraneural or extraneural injury. However, followup magnetic resonance imaging scans are necessary because evidence of the injury might not appear immediately. Late and recurrent spinal cord injuries without radiographic abnormalities are reported. External immobilization for 12 weeks helps patients who are moderately injured and helps prevent recurrence of these types of injuries. Approximately 44% of the patients in our study did not recover whereas complete recovery occurred in 39% of the population. The prognosis can be improved if the syndrome is diagnosed early, so we recommend considering spinal cord injuries without radiographic abnormalities as a possible diagnosis for any child who has a mechanism of injury that suggests trauma to the spine. LEVEL OF EVIDENCE: Therapeutic study, Level III-3 (case-control study). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2005

Effect of prophylactic amiodarone on clinical and economic outcomes after cardiothoracic surgery: a meta-analysis.

BACKGROUND: Two previous meta-analyses of amiodarone for prevention of postoperative atrial fibrillation (POAF) after cardiothoracic surgery did not evaluate total hospital cost, concluded that data on stroke are incomplete, and did not evaluate the effect of clinical heterogeneity between trials. OBJECTIVE: To conduct a meta-analysis examining amiodarone's prophylactic impact on cardiothoracic surgery POAF, length of stay (LOS), stroke, and total costs. METHODS: Three reviewers conducted a systematic literature search of MEDLINE, EMBASE, CINAHL, and the Cochrane Library (1966-SEPTEMBER 2004). Studies were included if they met the following criteria: (1) randomized controlled trial versus placebo/routine treatment, (2) coronary artery bypass graft and/or valvular surgery, (3) Jadad score > or = 3, (4) reported data on incidence of POAF or stroke, LOS, or total costs, (5) used electrocardiographic/Holter monitoring, and (6) monitored subjects for > or = 2 days. A random-effects model was utilized. Subgroup and sensitivity analyses were conducted. RESULTS: Fifteen trials were identified, including 1512 and 1429 patients in the amiodarone and control groups, respectively. Amiodarone reduced POAF (OR 0.50; 95% CI 0.42 to 0.60) and decreased stroke (n = 8 studies), LOS (n = 10), and total costs (n = 6) (OR 0.47; 95% CI 0.23 to 0.96; -0.73 days, 95% CI -0.95 to -0.51; and -dollar 1619, 95% CI -3395 to 156, respectively). Surgery type, beta-blocker use, route of administration, use of a fixed-effects model, or exclusion of unblinded/unpublished studies did not affect the overall results. No statistical heterogeneity was observed for any endpoint evaluated (p > 0.22 for all comparisons). CONCLUSIONS: Prophylactic treatment with amiodarone decreases patients' risk of POAF and stroke while reducing LOS.

Aged↗

PubMed1995

Diagnostic value of GM1 antibodies in motor neuron disorders and neuropathies: a meta-analysis.

We performed a meta-analysis on the diagnostic value of IgM anti-GM1 antibodies. The reported frequencies of IgM anti-GM1 antibodies ranged from 0 to 100% for patients with multifocal motor neuropathy (MMN), from 0 to 33% in the Guillain-Barré syndrome, from 0 to 65% in amyotrophic lateral sclerosis (ALS), from 0 to 77% in chronic inflammatory demyelinating neuropathy, and from 0 to 81% in lower motor neuron disease (LMND). However, using funnel graphs and a chi-square test we determined that the method of ELISA was the most important factor explaining these differences. After allowing for two factors--the use of detergent and the duration and temperature of serum incubation-studies became homogeneous in all but the LMND group of method A (no detergent, duration of serum incubation 5 hours) and the ALS group of method B (no detergent, duration of serum incubation at least 12 hours [overnight]). Since the anti-GM1 antibody assay serves to confirm clinical suspicion of MMN rather than to exclude the disease, specificity is more important than sensitivity. ELISA methods that do not use detergent and that incubate serum overnight resulted in a specificity of 90% and sensitivity of 38% in the comparison of MMN and LMND. With these values we calculated incremental ruling-in and ruling-out gain curves. Prior probabilities between 20 and 60% for having MMN changed to post-test probabilities between 50 and 85%, which is of clinical importance. In conclusion, ELISA is a useful diagnostic test to demonstrate IgM anti-GM1 antibodies provided the methods do not use detergent and do incubate serum overnight.

Antibodies↗

PubMed1995

Perioperative blood transfusion and cancer recurrence: meta-analysis for explanation.

BACKGROUND: Meta-analysis was used to explain disagreements across observational studies in regard to the association between perioperative transfusion and cancer recurrence. STUDY DESIGN AND METHODS: Observational studies published in English from 1982 through 1994 were retrieved. Five or more articles published in complete form were identified for each of six cancer sites: colorectum, breast, head and neck, lung, prostate, and stomach. Necessary information for building a 2 x 2 contingency table could be extracted from 60 studies. Summary relative risks (RR) reflecting the "average" adverse transfusion effect were computed for each cancer site by the random-effects method. Seven study characteristics were examined as potential explanations for the disagreements among the published studies. RESULTS: Before any adjustment for the effect of confounding, computed crude summary RRs suggested a significant (p < 0.05) deleterious transfusion effect in all cancer sites, except for breast. The RR of an adverse outcome was 1.49 in colorectal cancer (95% CI, 1.23-1.79) and ranged from 1.06 in breast cancers to 3.62 in head and neck cancers. The disagreements among published studies were most marked in the case of colorectal and gastric cancers. These discrepancies could be explained, in part, by study design, because prospective investigations had not produced a significant unadjusted transfusion effect (RR = 1.18; 95% CI, 0.93-1.51 in the case of colorectal cancer). CONCLUSION: A reduction in the size of the computed unadjusted transfusion effect (of an appropriate magnitude to adjust for the effect of confounding) might eliminate the significance of the average adverse effect in most studied cancer sites. Whether the entire unadjusted transfusion effect should be ascribed to the effect of confounding or whether a true, deleterious transfusion effect also exists can be resolved only by randomized controlled trials.

Breast Neoplasms↗

PubMed1994

[The clinical development of an antiemetic in oncology. A meta-analysis].

BACKGROUND: To perform meta-analysis (MT) on antiemetic efficacy of LAS 30451 (Pancopride) in high and moderately emetogenic chemotherapy (CT). METHODS: The results of 13 phase II and III clinical trials comparing the efficacy of different doses of the drug under study with or without corticoids, or versus standard treatment (methochlopramide and/or corticosteroids and diphenhydramine) were included. The principal variable was complete protection in the acute phase (0 vomiting following 24 h post treatment). RESULTS: The design was open in 3, simple blind in 4 and double blind in 6, with 11 being parallel and 2 crossed. The trials were carried out in 39 centers of 5 countries with 999 patients who received 1,292 cycles of antiemetic treatment. On comparison of lower or equal doses at 0.2 mg/kg of pancopride vs higher doses global OR was 0.94 (p = 0.72) with a global percentage difference (GPD) of -4.69% (p = 0.23) and GPD equal to -6.90. On treatment without cysplatin global OFR was equal to 1.10 (p = 0.69) with GPD of -8.99% favoring dosage lower than or equal to 0.2 mg/kg. The dexamethasone increased antiemetic efficacy of pancopride in both treatments with cysplatin (50% vs 76%, p = 0.08) and without cysplatin (50% to 89%, p = 0.02). When pancopride was compared with that of standard antiemetic treatment (methochlopramide and/or corticosteroids) global OR was equal to 0.69 (p = 0.07) with GPD of -6.84% favoring the control treatment. In CT containing cysplatin, global OR was equal to 0.73 (p = 0.38) with GPD of -3.28% and with CT without cysplatin the global OR was 0.66. (p = 0.12) with a GPD of -4.92% in both cases favoring the control treatment. CONCLUSIONS: No statistically significant differences were observed with regard to the antiemetic efficacy of pancopride on comparison of different doses of the drug. The antiemetic efficacy of pancopride increases when given together with dexamethasone. The efficacy of pancopride is lower to that of methochlopramide in combination with corticosteroids and/or diphenhydramine although the differences are not statistically significant.

Antiemetics↗

PubMed1990

Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited.

This paper reports a follow-up of previous meta-analysis research conducted by the author on the effects of diabetes patient education on patient outcomes. An expanded sample of studies and psychological outcome variables were added to the previously studied variables of patient knowledge, self-care behaviors (compliance and skill performance) and metabolic control. The purpose was to determine: (1) the effects of patient education on specific outcome variables; and (2) the relationships between effects of education and characteristics of the studies and/or subjects. Following an extensive literature search, a total of 82 studies were found which met the inclusion criteria for this analysis; 68% were published and 32% were unpublished. Homogeneity analyses of specific patient outcome variables yielded the following results: knowledge effects ranged from 0.49 to 1.05; self-care behavior effects from 0.17 to 0.57, with insulin injection and weight loss associated with the smallest effect sizes; metabolic control from 0.16 to 0.41; and psychological outcomes 0.27. Mean age of the subjects was negatively correlated with knowledge and cholesterol, indicating that the older the mean age of the subjects, the lower the effects of patient education on these variables. Findings of this meta-analysis on the expanded data set were consistent with the previous meta-analysis and lend support to the effectiveness of diabetes patient education in improving patient outcomes.

Diabetes Mellitus↗

PubMed2006

Are American College of Rheumatology 50% response criteria superior to 20% criteria in distinguishing active aggressive treatment in rheumatoid arthritis clinical trials reported since 1997? A meta-analysis of discriminant capacities.

OBJECTIVE: To carry out a meta-analysis designed to compare the discriminant capacities of American College of Rheumatology 50% (ACR50) with 20% (ACR20) responses in clinical trials on rheumatoid arthritis reported after 1997 and to analyse whether ACR50 can be as informative as ACR20 in distinguishing active from control treatments in more recent trials. METHODS: Clinical trials on rheumatoid arthritis reported since 1997 were identified, which included aggressive combinations of disease-modifying antirheumatic drugs and glucocorticoids, as well as powerful new agents-leflunomide, etanercept, infliximab, anakinra, adalimumab, abatacept, tacrolimus and rituximab. A meta-analysis of ACR20 compared with ACR50 responses for 21 clinical trials was carried out on differences in proportions of responders for active and control treatments and corresponding odds ratios (ORs). RESULTS: In all but one clinical trial on rheumatoid arthritis published since 1997 with data available on ACR20 and ACR50, more than 50% of patients who were ACR20 responders among those randomised to active treatment were also ACR50 responders. This phenomenon was seen for control groups in 38% of trials, many of which included treatment with methotrexate. A meta-analysis of the clinical trials indicated a slight advantage to ACR50 for quantifying treatment comparisons, not significant for differences in proportions but significant for ORs. CONCLUSION: ACR20 and ACR50 seem to be similar in distinguishing active from control treatments in clinical trials on rheumatoid arthritis reported since 1997. As ACR50 represents a considerably stronger clinical response, ACR50 may be a preferred end point for contemporary clinical trials on rheumatoid arthritis.

Antirheumatic Agents↗

PubMed2001

Meta-analysis: recent developments in quantitative methods for literature reviews.

We describe the history and current status of the meta-analytic enterprise. The advantages and historical criticisms of meta-analysis are described, as are the basic steps in a meta-analysis and the role of effect sizes as chief coins of the meta-analytic realm. Advantages of the meta-analytic procedures include seeing the "landscape" of a research domain, keeping statistical significance in perspective, minimizing wasted data, becoming intimate with the data summarized, asking focused research questions, and finding moderator variables. Much of the criticism of meta-analysis has been based on simple misunderstanding of how meta-analyses are actually carried out. Criticisms of meta-analysis that are applicable are equally applicable to traditional, nonquantitative, narrative reviews of the literature. Much of the remainder of the chapter deals with the processes of effect size estimation, the understanding of the heterogeneity of the obtained effect sizes, and the practical and scientific importance of the effect sizes obtained.

Humans↗

PubMed1997

[Methods of investigation in clinical cardiology. VIII. Meta-analysis and systematic reviews in cardiology].

Over the last 20 years, the development of meta-analysis has been aimed at obtaining objective synthesis of the available results on specific research questions. The main achievements of meta-analysis include the application of techniques to perform systematic literature searches and to obtain unbiased selection of studies, data extraction and pooled estimates of effect. This paper discusses the methodologic steps to follow when conducting a meta-analysis, with emphasis on study selections, data collection and statistical methods to combine the results from individual studies. We also present a set of guided questions as an aid to critically evaluate the conclusions of published meta-analyses. The application of meta-analytic techniques to cardiology is illustrated using a meta-analysis of the randomized controlled trials of angioplasty versus bypass surgery in the management of patients with ischemic heart disease.

Cardiology↗