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Results for “Meta- analysis”

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PubMed2003

History of depression and smoking cessation outcome: a meta-analysis.

The authors conducted a meta-analysis of published studies to (a) evaluate the premise that a history of major depression is associated with failure to quit smoking and (b) identify factors that moderate the relationship between history of depression and cessation outcome. Fifteen studies met the selection requirements and were coded for various study methodology and treatment characteristics. DSTAT was used to calculate individual study effect sizes, determine the mean effect size across studies, and test for moderator effects. No differences in either short-term (< or = 3 months) or long-term abstinence rates (> or = 6 months) were observed between smokers positive versus negative for history of depression. Lifetime history of major depression does not appear to be an independent risk factor for cessation failure in smoking cessation treatment.

Adult↗

PubMed2001

Efficacy of patient letter reminders on cervical cancer screening: a meta-analysis.

OBJECTIVE: To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears. METHODS: A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed. RESULTS: Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity (chi2 = 31, 9 df, P <.001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity (chi2 = 5.2, 8 df, P =.75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80). CONCLUSIONS: Patient reminders in the form of mailed letters increase the rate of cervical cancer screening. Patient letter reminders have less efficacy in lower socioeconomic groups.

Adolescent↗

PubMed1995

Strategies for teaching patients: a meta-analysis.

The purpose of this meta-analysis was to synthesize the existing body of research examining teaching strategies used in patient education. An extensive literature search revealed 72 studies that met inclusion criteria. Studies were coded for general, substantive, and methodological characteristics, and an effect size was generated for each study. Mean effect size was 0.41, indicating that 66% of subjects receiving planned teaching had better outcomes than did control group subjects receiving routine care. Structure yielded the highest effect size, with reinforcement, independent study, and use of multiple strategies also above the study mean. Differences in mean effect size were also found in other variables (type of outcome measure, teaching content, type of instructional media, type of learning activity, retention of learning, quality of study methods, and publication date). Implications for research and clinical practice are discussed.

Humans↗

PubMedDate not supplied

Nursing intervention and smoking cessation: A meta-analysis.

OBJECTIVE: To determine with meta-analysis the effects of nursing-delivered smoking cessation interventions. RESULTS: Fifteen studies comparing nursing intervention with a control or usual care found intervention to significantly increase the odds of smoking cessation. There was heterogeneity among the study results, but pooling by using a random effects model did not alter the estimate of effect. There was no evidence from indirect comparison that interventions classified as intensive had a larger effect than less intensive ones. There was evidence that interventions were more effective for hospital inpatients with cardiovascular disease than for inpatients with other conditions. Interventions in nonhospitalized patients also showed evidence of efficacy. Nurse counseling on smoking cessation during a screening health check was likely to have less effect. The results indicate the potential benefits of smoking cessation advice and counseling given by nurses to their patients, with reasonable evidence that intervention can be effective.

Adult↗

PubMed2006

Does expressive writing reduce health care utilization? A meta-analysis of randomized trials.

This meta-analysis examined whether writing about stressful experiences affects health care utilization (HCU) compared with writing on neutral topics or no-writing control groups. Randomized controlled trials of 30 independent samples representing 2,294 participants were located that contained sufficient information to calculate effect sizes. After omitting one study as an outlier, the effects were combined within 3 homogeneous groups: healthy samples (13 studies), samples with preexisting medical conditions (6 studies), and samples prescreened for psychological criteria (10 studies). Combined effect sizes, Hedges's g (95% confidence interval), with random effects estimation were 0.16 (0.02, 0.31), 0.21 (-0.02, 0.43), and 0.06 (-0.12, 0.24), respectively. Writing about stressful experiences reduces HCU in healthy samples but not in samples defined by medical diagnoses or exposure to stress or other psychological factors. The significance of these effects for individuals' health is unknown.

Health Services↗

PubMed2004

Psychological treatments for irritable bowel syndrome: a systematic review and meta-analysis.

This study conducted a systematic review to assess the quality of existing literature on psychological treatments for irritable bowel syndrome and to quantify the evidence for their efficacy. Three independent reviewers (2 from England, 1 from the United States) coded the quality of 32 studies, 17 of which provided data suitable for meta-analysis. Meta-analysis of efficacy data (50% reduction of symptoms) gave an odds ratio of 12 (95% confidence interval = 5.56-25.96) and a number needed to treat of 2. Psychological treatments are, as a class of interventions, effective in reducing symptoms compared with a pooled group of control conditions. Questions regarding the relative superiority of specific psychological treatments and influence of active versus nonspecific treatment effects remain unanswered.

Humans↗

PubMed2004

Benefits of antithrombotic therapy after infrainguinal bypass grafting: a meta-analysis.

PURPOSE: We performed a meta-analysis to ascertain the benefits of antithrombotic therapy for maintaining the patency of vascular grafts following lower extremity bypass operations. METHODS: We identified articles using MEDLINE and hand searches of relevant journals for randomized clinical trials that compared the use of antithrombotic therapy with control or placebo therapy. Random-effects (DerSimonian and Laird) analyses were used to determine the risk of graft occlusion following lower extremity bypass operations. We also assessed the odds of secondary outcomes, such as myocardial infarction, cerebrovascular accident, all-cause mortality, and bleeding. RESULTS: Sixteen articles met the inclusion criteria of a randomized trial of antithrombotic therapy for the patency of vascular grafts; six were excluded because the analyses involved repeat surgeries or lacked a control group. Of the 10 studies included in the final analysis, seven compared antiplatelet agents with placebo or control, and three compared anticoagulant agents with placebo or control. The 10 studies were homogeneous in spite of differing durations of follow-up. The odds of graft occlusion in the treated group was half that in the placebo or control group. The odds ratio was 0.46 (95% confidence interval [CI]: 0.32 to 0.66) for the 10 studies that reported outcomes at 12 months or longer, 0.50 (95% CI: 0.29 to 0.87) in the five studies with 12-month rates; and 0.58 (95% CI: 0.39 to 0.88) at 24 months. CONCLUSION: Antithrombotic therapy decreases the risk of graft occlusion after a vascular operation by about 50% at 12 months and is still protective at 24 months after the operation.

Fibrinolytic Agents↗

PubMed2006

Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis.

OBJECTIVE: We sought to meta-analyze the effects of different modes of exercise training on measures of glucose control and other risk factors for complications of diabetes. RESEARCH DESIGN AND METHODS: The 27 qualifying studies were controlled trials providing, for each measure, 4-18 estimates for the effect of aerobic training, 2-7 for resistance training, and 1-5 for combined training, with 1,003 type 2 diabetic patients (age 55 +/- 7 years [mean +/- between-study SD]) over 5-104 weeks. The meta-analytic mixed model included main-effect covariates to control for between-study differences in disease severity, sex, total training time, training intensity, and dietary cointervention (13 studies). To interpret magnitudes, effects were standardized after meta-analysis using composite baseline between-subject SD. RESULTS: Differences among the effects of aerobic, resistance, and combined training on HbA(1c) (A1C) were trivial; for training lasting >/=12 weeks, the overall effect was a small beneficial reduction (A1C 0.8 +/- 0.3% [mean +/- 90% confidence limit]). There were generally small to moderate benefits for other measures of glucose control. For other risk factors, there were either small benefits or effects were trivial or unclear, although combined training was generally superior to aerobic and resistance training. Effects of covariates were generally trivial or unclear, but there were small additional benefits of exercise on glucose control with increased disease severity. CONCLUSIONS: All forms of exercise training produce small benefits in the main measure of glucose control: A1C. The effects are similar to those of dietary, drug, and insulin treatments. The clinical importance of combining these treatments needs further research.

Blood Glucose↗

PubMed1995

A meta-analysis of bibliotherapy studies.

Used meta-analysis to examine the efficacy of bibliotherapy. Bibliotherapy treatments were compared to control groups and therapist-administered treatments. The mean estimated effect size (d) of the 70 samples analyzed was + 0.565. There was no significant differences between the effects of bibliotherapy and therapist-administered treatments, as well as no significant erosion of effect sizes at follow-up. Bibliotherapy did appear more effective for certain problem types (assertion training, anxiety, and sexual dysfunction) than for others (weight loss, impulse control, and studying problems). Overall the amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research on the commonly purchased books and moderator analyses by personality type and reading ability.

Bibliotherapy↗

PubMed2005

Physical activity and psychological well-being in advanced age: a meta-analysis of intervention studies.

A meta-analysis examined data from 36 studies linking physical activity to well-being in older adults without clinical disorders. The weighted mean-change effect size for treatment groups (d(C). = 0.24) was almost 3 times the mean for control groups (d(C). = 0.09). Aerobic training was most beneficial (d(C). = 0.29), and moderate intensity activity was the most beneficial activity level (d(C). = 0.34). Longer exercise duration was less beneficial for several types of well-being, though findings are inconclusive. Physical activity had the strongest effects on self-efficacy (d(C).= 0.38), and improvements in cardiovascular status, strength, and functional capacity were linked to well-being improvement overall. Social-cognitive theory is used to explain the effect of physical activity on well-being.

Activities of Daily Living↗

PubMed2004

A comparison of the efficacy and safety of nonsteroidal antiinflammatory agents versus acetaminophen in the treatment of osteoarthritis: a meta-analysis.

OBJECTIVE: To perform a meta-analysis comparing the efficacy and safety of recommended dosages of nonsteroidal antiinflammatory drugs (NSAIDs), including cyclooxygenase 2 inhibitors, versus acetaminophen in the treatment of symptomatic hip and knee osteoarthritis. METHODS: Medline and EMBASE searches were performed for original clinical trials directly comparing NSAIDs with acetaminophen. A standardized form was used to abstract all data, including outcome measures of pain at rest, walking pain, and dropouts due to adverse effects. Inverse-variance-weighted mean differences (WMDs) and 95% confidence intervals (95% CI) for pain measures were determined for treatment groups. Odds ratios (ORs) and 95% CIs were calculated for withdrawals due to adverse events. Results were compared using a random effects model. RESULTS: Seven articles met inclusion criteria with sufficient data for analysis. Participants had a mean age of 61.1 years and 71.1% were women. Test of heterogeneity was not significant for either rest (P = 0.73) or walking (P = 0.76) pain. The scores for overall pain at rest (WMD -6.33 mm on a 100-mm visual analog scale [VAS], 95% CI -9.24, -3.41) and walking pain (WMD -5.76 mm on a 100-mm VAS, 95% CI -8.99, -2.52) favored the NSAID-treated group. Although NSAIDs elevated the risk of withdrawals due to adverse events, the difference was not statistically significant (OR 1.45, 95% CI 0.93, 2.27). CONCLUSION: NSAIDs are statistically superior in reducing rest and walking pain compared with acetaminophen for symptomatic osteoarthritis. Safety, measured by discontinuation due to adverse events, was not statistically different between NSAID- and acetaminophen-treated groups.

Acetaminophen↗

PubMed2000

The role of frozen section, gender, age, and tumor size in the differentiation of follicular adenoma from carcinoma: a meta-analysis.

BACKGROUND: The purpose of this study was to reanalyze modern trials and use meta-analysis to determine how well frozen section gender, age, and tumor size could differentiate follicular adenoma from follicular carcinoma. METHOD: Inclusion criteria were studies where patients had a permanent pathologic diagnosis of follicular adenoma or follicular carcinoma and underwent frozen section or had clinical features recorded. Data were pooled, and the random effects model of meta-analysis was used. A probability value of less than.05 was considered significant. RESULTS: Nineteen studies were included (n = 3486 patients). Frozen section was evaluated in 11 studies (n = 2204 patients). Frozen section had an 87% sensitivity, a 48% specificity, a 92% and 35% positive and negative predictive value, respectively, an 82% accuracy, an odds ratio of 0.181, a 95% confidence interval (CI) of 0.07 to 0.49, and a probability value of.001. Clinical features were evaluated in 10 studies (n = 1954 patients). Of the patients with follicular carcinoma, 27.5% were male compared with patients with follicular adenoma, of whom 17.7% were male (P <.01; odds ratio, 2.17; CI 1.3-3.6; P =.003). Of the patients with follicular carcinoma, 52.2% were older than 50 years (52.2%) compared with patients with follicular adenoma, of whom 28.5% were older than 50 years (P <.001). Of patients with follicular carcinoma, 36.8% had tumors larger than 3 to 5 cm compared with patients with follicular adenoma, of whom 14.7% had tumors larger than 3 to 5 cm (P <.001; odds ratio, 3.99; CI 1.5-10.8; P =.006). CONCLUSIONS: Meta-analysis suggests that frozen section is not a specific test and cannot be used to confidently rule out follicular carcinoma. Male gender and large tumor size are significantly associated with carcinoma.

Adenoma↗

PubMed2005

Efficacy of postoperative patient-controlled and continuous infusion epidural analgesia versus intravenous patient-controlled analgesia with opioids: a meta-analysis.

The authors performed a meta-analysis and found that epidural analgesia overall provided superior postoperative analgesia compared with intravenous patient-controlled analgesia. For all types of surgery and pain assessments, all forms of epidural analgesia (both continuous epidural infusion and patient-controlled epidural analgesia) provided significantly superior postoperative analgesia compared with intravenous patient-controlled analgesia, with the exception of hydrophilic opioid-only epidural regimens. Continuous epidural infusion provided statistically significantly superior analgesia versus patient-controlled epidural analgesia for overall pain, pain at rest, and pain with activity; however, patients receiving continuous epidural infusion had a significantly higher incidence of nausea-vomiting and motor block but lower incidence of pruritus. In summary, almost without exception, epidural analgesia, regardless of analgesic agent, epidural regimen, and type and time of pain assessment, provided superior postoperative analgesia compared to intravenous patient-controlled analgesia.

Analgesia, Epidural↗

PubMed1994

Selective serotonin reuptake inhibitors: meta-analysis of discontinuation rates.

A meta-analysis was carried out of 42 published randomized controlled studies comparing the selective serotonin reuptake inhibitors (SSRIs) with the tricyclic antidepressants (TCAs) that measured discontinuation rates for side effects and lack of efficacy by treatment group in order to compare the discontinuation rates for side effects and lack of efficacy. These discontinuation rates were pooled to produce the main outcome measure. Seven studies were placebo controlled and the discontinuation rates in these studies were also pooled in a separate analysis. Significantly fewer patients receiving SSRIs discontinued treatment because of side effects (14.9%) compared with those receiving TCAs (19%) (p < 0.01). There was also a significant difference in discontinuation rates due to side effects in the placebo- and TCA-controlled studies analysed separately, SSRIs (19%) compared with TCAs (27%) (p < 0.01). In both analyses a similar proportion of patients discontinued for lack of efficacy on SSRIs and TCAs. There is a significant and clinically important advantage for the SSRIs compared with the TCAs in the acceptability of treatment measured by the number of discontinuations due to side effects reported in published studies. The risk-benefit calculation favours the SSRIs since there were similar levels of efficacy but more discontinuations with the TCAs. The selection of an antidepressant for first-line treatment requires critical evaluation of the full risk-benefit equation.

Antidepressive Agents, Tricyclic↗

PubMed2002

Detection of hepatic metastases from cancers of the gastrointestinal tract by using noninvasive imaging methods (US, CT, MR imaging, PET): a meta-analysis.

PURPOSE: To perform a meta-analysis to compare current noninvasive imaging methods (ultrasonography [US], computed tomography [CT], magnetic resonance [MR] imaging, and (18)F fluorodeoxyglucose [FDG] positron emission tomography [PET]) in the detection of hepatic metastases from colorectal, gastric, and esophageal cancers. MATERIALS AND METHODS: A MEDLINE literature search and review of article bibliographies and our institutional charts of patients with colorectal cancer identified data with histopathologic correlation or at least 6 months of patient follow-up. Two authors independently abstracted data sets and excluded data without contingency tables or data published more than once. Summary-weighted estimates of sensitivity were obtained and stratified according to specificity of less than 85% or 85% and higher. A covariate analysis was used to evaluate the influence of patient- or study-related factors on sensitivity. RESULTS: Among 111 data sets, nine US (509 patients), 25 CT (1,747 patients), 11 MR imaging (401 patients), and nine PET (423 patients) data sets met the inclusion criteria. In studies with a specificity higher than 85%, the mean weighted sensitivity was 55% (95% CI: 41, 68) for US, 72% (95% CI: 63, 80) for CT, 76% (95% CI: 57, 91) for MR imaging, and 90% (95% CI: 80, 97) for FDG PET. Results of pairwise comparison between imaging modalities demonstrated a greater sensitivity of FDG PET than US (P =.001), CT (P =.017), and MR imaging (P =.055). CONCLUSION: At equivalent specificity, FDG PET is the most sensitive noninvasive imaging modality for the diagnosis of hepatic metastases from colorectal, gastric, and esophageal cancers.

Colorectal Neoplasms↗

PubMed1989

Corticosteroids as adjunctive therapy in bacterial meningitis. A meta-analysis of clinical trials.

A meta-analysis of all nine available controlled trials of corticosteroids for adjunctive therapy for bacterial meningitis was performed. Risks of various outcomes were assessed for control and treatment groups from each study, and risk differences were determined. For each outcome a weighted average of the individual risk differences was calculated. The results show that corticosteroid administration did not reduce the risk of death or neurologic abnormality at hospital discharge or follow-up examination. Based on statistically combined results of the three most recent trials, there is evidence that dexamethasone reduces the risk of bilateral moderate or more severe hearing loss (risk difference, -9%; 95% confidence limits, -15% and -3%). However, this may be true only for children with meningitis caused by Haemophilus influenzae type b. There are inadequate data in adults or in children with meningitis due to other organisms to demonstrate the benefit of dexamethasone administration. Further study is necessary to fully assess the benefits and risks of corticosteroids for adjunctive therapy for bacterial meningitis.

Adrenal Cortex Hormones↗

PubMed1995

Omeprazole and H2-receptor antagonists in the acute treatment of duodenal ulcer, gastric ulcer and reflux oesophagitis: a meta-analysis.

This paper is a meta-analysis of 30 published, double-blind clinical trials comparing omeprazole with ranitidine or cimetidine for the treatment of duodenal ulcer, gastric ulcer and reflux oesophagitis. These studies compare the recommended doses of omeprazole with those for ranitidine and cimetidine, and the confidence intervals for the therapeutic gain show that the findings are highly reliable. The difference in healing rates favoured omeprazole over ranitidine in patients with duodenal ulcer after 2 weeks of treatment (15.2 percentage units; P < 0.001), and after 4 weeks of treatment in patients with gastric ulcer (9.9 percentage units; P = 0.005), or reflux oesophagitis (23 percentage units; P < 0.001). Similarly, omeprazole gave a 20.6 percentage units higher average healing rate than cimetidine in patients with duodenal ulcer after 2 weeks of treatment (P < 0.0001). Significantly more patients treated with omeprazole were free of symptoms at their first follow-up visit than patients treated with ranitidine or cimetidine.

Adult↗

PubMed2001

Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes: a meta-analysis.

OBJECTIVE: We performed a meta-analysis to examine the role of antibiotic prophylaxis in preventing postoperative infections among nonlaboring women undergoing cesarean delivery with intact membranes. STUDY DESIGN: A computerized literature search was performed with MEDLINE. Studies were included if they contained data on patients undergoing cesarean delivery in the absence of labor and ruptured membranes. Only randomized trials with a placebo control group were included. RESULTS: Seven studies were found. Use of antibiotics decreased the risk of all infectious outcomes reported. When the results of 4 studies were pooled, prophylactic antibiotic use was associated with a significant reduction in postoperative fever (relative risk, 0.25; 95% confidence interval, 0.14-0.44). A similar reduction was noted for endometritis in 4 studies (relative risk, 0.05; 95% confidence interval, 0.01-0.38). Two studies reported on wound infection and showed a trend toward a protective effect (relative risk, 0.59; 95% confidence interval, 0.24-1.45). CONCLUSION: The prophylactic use of antibiotics reduces the risk of postoperative infectious complications after cesarean delivery even in the population at lowest risk.

Antibiotic Prophylaxis↗