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Results for “Meta- analysis”

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PubMed2000

Steroids for multiple sclerosis and optic neuritis: a meta-analysis of randomized controlled clinical trials.

We conducted a meta-analysis of randomized controlled clinical trials on steroid treatment for multiple sclerosis and optic neuritis. Of the 25 trials comparing steroids and controls without steroid treatment that we identified 12 were selected for this review. A meta-analysis was conducted to calculate the overall odds ratio across the studies for the numbers of patients without functional improvement and with new relapses. The trials included a total of 1714 patients: 998 with multiple sclerosis and 716 with optic neuritis. Any type of corticosteroids or adrenocorticotropic hormone (ACTH) treatment was considered, as was any dosage, route of administration, and length of treatment. Main outcome measures were: (a) number of multiple sclerosis patients who did not improve by at least one point on the EDSS or equivalent scale, or number of optic neuritis patients without complete recovery of visual acuity at 8 or 30 days and at longer follow-up; (b) number of multiple sclerosis patients with at least one new relapse, or number of optic neuritis patients in whom definite multiple sclerosis was diagnosed at longer follow-up. We found that corticosteroids or ACTH produced a significant improvement in disability or visual acuity at 30 days (odds ratio 0.49; 95% CI 0.37-0.64). The improvement was not statistically significant at longer follow-up (0.85; 95% CI 0.67-1.09). The treatment did not significantly reduce the number of patients with relapses (0.74; 95% CI 0.54-1.01). Both low and high doses were effective for 30-day improvement, but only high-dose and short-term therapy were factors that identified subgroups with some reduction in the risk of new relapse. However, the power of the statistical analysis to detect a reliable difference in the subgroups was low. Steroid treatment is therefore effective in accelerating short-term recovery in patients with multiple sclerosis or optic neuritis. Whether steroids are also effective in reducing the risk of relapse, and the optimal dose and length of treatment must still be determined.

Disability Evaluation↗

PubMed2003

Transformational, transactional, and laissez-faire leadership styles: a meta-analysis comparing women and men.

A meta-analysis of 45 studies of transformational, transactional, and laissez-faire leadership styles found that female leaders were more transformational than male leaders and also engaged in more of the contingent reward behaviors that are a component of transactional leadership. Male leaders were generally more likely to manifest the other aspects of transactional leadership (active and passive management by exception) and laissez-faire leadership. Although these differences between male and female leaders were small, the implications of these findings are encouraging for female leadership because other research has established that all of the aspects of leadership style on which women exceeded men relate positively to leaders' effectiveness whereas all of the aspects on which men exceeded women have negative or null relations to effectiveness.

Administrative Personnel↗

PubMed1998

Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials.

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptomes of PTSD and general psychological symptomes (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2-.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.

Clinical Trials as Topic↗

PubMed1995

Effects of psychotherapy with children and adolescents revisited: a meta-analysis of treatment outcome studies.

A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age x Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study.

Adolescent↗

PubMed2003

Vitamin A supplementation and childhood morbidity from diarrhea and respiratory infections: a meta-analysis.

OBJECTIVES: To perform an updated meta-analysis of the effect of vitamin A supplementation on childhood morbidity from respiratory tract infections and diarrhea. Study design A comprehensive search of the 1966 to 2000 MEDLINE database and review of the reference lists of relevant articles identified 9 randomized controlled trials dealing with morbidity from respiratory infections and diarrhea in children 6 months to 7 years of age and provided "intention-to-treat" data. RESULTS: The combined results indicated that vitamin A supplementation has no consistent overall protective effect on the incidence of diarrhea (relative risk, 1.00; 95% CI, 0.94-1.07) and that it slightly increases the incidence of respiratory tract infections (relative risk, 1.08; 95% CI, 1.05-1.11). CONCLUSIONS: High-dose vitamin A supplements are not recommended on a routine basis for all preschool children and should be offered only to individuals or populations with vitamin A deficiency.

Child↗

PubMed2002

Subarachnoid haemorrhage occurrence exhibits a temporal pattern - evidence from meta-analysis.

The aim of the present meta-analysis was to determine a temporal pattern of occurrence of subarachnoid haemorrhage (SAH). A MEDLINE 1966-2001 and EMBASE (1980-2001) literature search and hand search of relevant references were performed for population-based incidence studies that reported the time of SAH occurrence. Data from all identified relevant studies were combined into a pooled rate ratio (RR), with corresponding 95% confidence intervals (CI) using the Mantel-Haenszel method. Overall, eight population-based studies were included in the analysis. A total of 2533 first-ever cases of SAH were reported in the studies identified. Risk of SAH occurrence was the highest in the period between 6 am and 12 am (RR = 3.19; 95% CI 3.03-3.36; early morning as a reference variable) and between 12 p.m. and 6 p.m. (RR = 2.63; 95% CI 2.47-2.80), in winter and spring (RR = 1.10; 95% CI: 1.02-1.17; and RR = 1.07; 95% CI: 1.01-1.13, respectively; summer as a reference variable) and on Sunday (RR = 1.22; 95% CI 1.09-1.37; Monday as a reference variable). The evidence suggests that occurrence of SAH exhibits a seasonal (winter and spring) peak, diurnal (late morning peak) and daily (Sunday peak) pattern. It is suggested that the occurrence of some major acute vascular events (total ischaemic strokes, intracerebral haemorrhage and myocardial infarction) may be influenced by common triggering factors.

Circadian Rhythm↗

PubMed1996

Cesarean childbirth and psychosocial outcomes: a meta-analysis.

A comprehensive literature review with meta-analysis examines the differences between vaginal and cesarean delivery on 23 psychosocial outcomes of childbirth. The most robust findings suggest that cesarean mothers, compared with mothers who delivered vaginally, expressed less immediate and long-term satisfaction with the birth, were less likely ever to breast-feed, experienced a much longer time to first interaction with their infants, had less positive reactions to them after birth, and interacted less with them at home. Some differences were also found between unplanned and planned cesarean sections; none were found between birthing methods for maternal confidence for infant caretaking soon after birth, maternal anxiety in the hospital and at home, maternal stress at home, maternal return to work, and continuation of breast-feeding once begun. Implications of these findings for theory, research, and childbirth practice are discussed.

Breast Feeding↗

PubMed2002

The heritability of alcohol abuse and dependence: a meta-analysis of behavior genetic research.

A meta-analysis was performed on 50 family, twin, and adoption studies in which problem drinking and alcohol dependence served as the primary criterion measure. The results showed that far from being an established "fact," the genetic foundations of alcohol misuse are modest and heterogeneous. A weighted mean phi effect size of 0.12 (95% Confidence Interval = 0.11-0.12) was obtained for the total sample of 72 effect sizes. Four potential moderator variables (proband gender, sample nationality, pattern severity, year of publication) were examined with outcomes confirming that the heritability of alcohol misuse is stronger in males and in studies employing more severe definitions of abuse (alcoholism, alcohol dependence). When the effect size measure was restricted to studies using male subjects with more severe diagnoses of alcohol misuse, the unweighted mean phi effect size was only 0.18 (95% Confidence Interval = 0.15-0.21), with an even smaller weighted mean phi effect size of 0.15 (95% Confidence Interval = 0.12-0.18); results which indicate an upper limit of 30-36% for the heritability of alcohol misuse.

Adoption↗

PubMed2006

Role of prophylactic antibiotic administration in severe acute pancreatitis: a meta-analysis.

OBJECTIVE: To carry out a meta-analysis of published studies in order to evaluate the clinical efficacy of prophylactic antibiotics in severe acute pancreatitis (SAP). MATERIAL AND METHODS: MEDLINE, China Biological Medicine, Embase and Cochrane Data Base for Systematic Reviews were searched for randomized controlled trials on the efficacy of prophylactic antibiotics in patients with SAP from 1966 to 2004. Six studies met our inclusion criteria. Two authors (G.S.X. and Z.H.W.) independently extracted the following data from these studies: trial design, characteristics of participants and outcomes. Data were analyzed by Revman 4.2 software. RESULTS: In patients with SAP, prophylactic antibiotics, including broad-spectrum antibiotics that usually achieve therapeutic pancreatic tissue levels, did not reduce pancreatic infection (relative risk, RR, 0.77, 95% confidence interval 0.48-1.24, p = 0.28), surgical intervention (RR 0.84, 95% confidence interval 0.40-1.74, p = 0.64) and mortality rate (RR 0.54, 95% confidence interval 0.28-1.04, p = 0.07). CONCLUSIONS: Prophylactic antibiotic administration is not an appropriate treatment strategy in patients with SAP, it should be limited in patients with pancreatic necrosis, as demonstrated by computerized tomography.

Acute Disease↗

PubMed2004

Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis.

BACKGROUND AND PURPOSE: Previously published meta-analyses exploring the effect of statins on stroke incidence included 20,000 patients and found a 2% to 30% risk reduction. It is not clear whether this is attributable to low-density lipoprotein-cholesterol (LDL-C) reduction. Statin trials have now included >90,000 patients. We have determined the effect of statins and LDL-C reduction on stroke prevention. SUMMARY OF REVIEW: We performed a systematic review and meta-analysis of all randomized trials testing statin drugs published before August 2003. The trials were identified using a computerized PubMed search. We analyzed separately statin effect on incident strokes and on carotid intima-media thickness (IMT) according to LDL-C reduction. The relative risk reduction for stroke was 21% (odds ratio [OR], 0.79 [0.73 to 0.85]), with no heterogeneity between trials. Fatal strokes were reduced but not significantly: by 9% (OR, 0.91 [0.76 to 1.10]). There was no increase in hemorrhagic strokes (OR, 0.90 [0.65 to 1.22]). Statin size effect was closely associated with LDL-C reduction. Each 10% reduction in LDL-C was estimated to reduce the risk of all strokes by 15.6% (95% CI, 6.7 to 23.6) and carotid IMT by 0.73% per year (95% CI, 0.27 to 1.19). CONCLUSIONS: Statins may reduce the incidence of all strokes without any increase in hemorrhagic strokes, and this effect is mainly driven by the extent of between-group LDL-C reduction. Carotid IMT progression also strongly correlated with LDL-C reduction.

Carotid Artery Diseases↗

PubMed2001

Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding.

BACKGROUND: This meta-analysis tested the hypothesis that cumulative blood loss during the first 24 hours after cardiopulmonary bypass is lower in patients exposed to albumin than hydroxyethyl starch (HES). METHODS: Randomized controlled trials comparing albumin and HES in cardiopulmonary bypass patients were identified by bibliographic database searches and other methods. RESULTS: Sixteen trials involving 653 randomized patients were included. In 88% of randomized comparisons, postoperative bleeding was lower in the albumin group, and the standardized mean difference in bleeding favoring albumin across all trials (-0.24; 95% confidence interval, -0.40 to -0.08) was statistically significant. Bleeding differences between albumin and either high or medium molecular weight HES were similar. In trials of adults, the pooled mean blood loss in the albumin group was 693+/-350 mL compared with 789+/-487 mL in the HES group. The estimated proportion of adult albumin group patients with blood loss of more than 1,000 mL was 19% compared with 33% of adult HES group patients. Conclusions. Postoperative blood loss is significantly lower in cardiopulmonary bypass patients exposed to albumin than HES.

Aged↗

PubMed1995

Is allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials.

A meta-analysis of clinical trials of allergen immunotherapy was undertaken to assess the efficacy of this controversial form of therapy in asthma. A computerized bibliographic search revealed 20 randomized placebo controlled double-blind trials of allergen immunotherapy for asthma. The results extracted included asthmatic symptoms, medication requirements, lung function, and bronchial hyperreactivity (BHR). Categorical outcomes were expressed as odds ratios and continuous outcomes as effect sizes. The combined odds of symptomatic improvement from immunotherapy with any allergen were 3.2 (95% CI 2.2 to 4.9). The odds for reduction in medication after mite immunotherapy were 4.2 (95% CI 2.2 to 7.9). The combined odds for reduction in BHR were 6.8 (95% CI 3.8 to 12.0). The mean effect size for any allergen immunotherapy on all continuous outcomes was 0.71 (95% CI 0.43 to 1.00), which would correspond to a mean 7.1% predicted improvement in FEV1 from immunotherapy. Although the benefits of allergen immunotherapy could be overestimated because of unpublished negative studies, an additional 33 such studies would be necessary to overturn these results. Allergen immunotherapy is a treatment option in highly selected patients with extrinsic ("allergic") asthma.

Asthma↗

PubMed1992

Dexamethasone and bacterial meningitis. A meta-analysis of randomized controlled trials.

A meta-analysis of 5 randomized, controlled trials using dexamethasone as adjunctive therapy in the treatment of bacterial meningitis in children was done to assess the efficacy in reducing sequelae. A 6th study including both children and adults was analyzed separately. Results of the 5 pediatric studies indicated no significant difference in case-fatality rate between the placebo and dexamethasone groups. Significantly more neurologic sequelae were found in the placebo group during the period from discharge from hospital to 6 weeks after discharge (relative risk [RR] = 1.99, 95% confidence interval [CI] 1.13 to 3.53) and during the period beginning 6 months after discharge (RR = 3.90, 95% CI 1.72 to 8.85). The incidence of neurologic sequelae from 6 weeks to 6 months after discharge, though less with dexamethasone administration, did not reach statistical significance. The frequency of bilateral hearing loss was significantly greater in the placebo group (RR = 4.12, 95% CI 1.74 to 9.79), but unilateral loss was not statistically different in the two groups. Dexamethasone administration in addition to antimicrobial therapy appears to be effective in reducing neurologic sequelae and bilateral hearing loss associated with bacterial meningitis in children.

Adult↗

PubMedDate not supplied

Impact of depression on experimental pain perception: a systematic review of the literature with meta-analysis.

OBJECTIVE: This systematic review and meta-analysis was performed to examine the impact of depression on the perception of experimental pain stimuli. METHODS: CD-ROM databases and bibliographies were searched to identify studies comparing the psychophysical responses to experimental pain stimuli of depressed subjects with that of healthy controls. Effect sizes (Cohen's d) and probabilities were combined across studies; positive effect sizes indicated higher thresholds in depressed groups. RESULTS: Six methodologically rigorous, independent studies were found comparing psychophysical responses to experimental pain stimuli in depressed subjects and healthy controls. Pain perception threshold was higher in depressed subjects (6 studies, d = 0.38, p =.001). This finding was not the result of publication bias. Absolute sensory perception threshold was much higher in depressed subjects (2 studies, d = 0.68, p =.002), though the findings for pain tolerance (2 studies) were too heterogeneous to enable us to combine results. CONCLUSIONS: Depressed subjects are less likely to perceive a sensory stimulus as being painful compared with nondepressed controls. The influence of depression on attention to the pain stimulus may account for this effect. More studies are required to enable us to determine the impact of depression on absolute sensory perception threshold and pain tolerance. Furthermore, more studies would enable the examination of depression on the perception of different modalities.

Attention↗

PubMed2004

Comparison of international dairy sire evaluations from meta-analysis of national estimated breeding values and direct analysis of individual animal performance records.

Our objective was to assess the predictive ability of different methodologies for international genetic evaluation of milk yield and to determine the magnitude of differences in the resulting sire estimated breeding values (EBV). Data included first lactation records of 16,057,335 Holstein-sired cows from 237,049 herds in 14 countries. Meta-analysis of national sire EBV using the multiple-trait across country evaluation (MACE) procedure, single-trait analysis of individual animal performance records, multiple-trait analysis of individual animal performance records, and borderless herd cluster model were compared by assessing predictive ability. Comparisons were based on root mean square error of sire EBV from a subset of records from cows calving between 1990 and 1995 and corresponding pedigree indices for sires that received their first genetic evaluations in 1996 or 1997. The number of bulls first evaluated in 1996 or 1997 that were in common between the top 25, 100, and 250 for pedigree index and the top 25, 100, and 250 for EBV were also determined for each method. Average root mean square error of prediction was 10.3 kg2 for the borderless single-trait model, 6.6 kg2 for the borderless herd cluster model, and 6.7 kg2 for both the borderless multiple-trait model and meta-analysis of national sire EBV using MACE. The mean numbers of common bulls among the top 25, 100, and 250, respectively, when selected on pedigree index and subsequent EBV were 11, 48, and 154 for the borderless single-trait model; 16, 66, and 176 for the borderless multiple-trait model; 16, 66, and 178 for the borderless herd cluster model; and 15, 66, and 178 for meta-analysis of national sire EBV using MACE. Rank correlations between sire EBV from different models ranged from 0.77 for the single-trait borderless model and the meta-analysis using MACE to 0.92 for the borderless multiple-trait and the borderless herd cluster models.

Animals↗

PubMed2026

Nonoperative Management is Associated With Similar Long-Term Patient-Reported Outcomes Compared With Surgery for Cervical Radiculopathy: A Systematic Review and Meta-analysis.

STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To compare long-term patient-reported outcomes between surgical and nonoperative management for cervical radiculopathy. SUMMARY OF BACKGROUND DATA: Cervical radiculopathy is a common condition associated with substantial morbidity. While both surgical and nonoperative approaches are effective, it remains unclear which patients benefit most from each strategy and whether earlier operative intervention confers meaningful long-term advantage. MATERIALS AND METHODS: PubMed, Embase, and the Cochrane Library were searched from inception to January 2026 for randomized and observational studies comparing surgical and nonoperative management for cervical radiculopathy. Primary outcomes included visual analog scale (VAS) scores for neck and arm pain, neck disability index (NDI), and overall clinical success. Secondary outcomes included analgesia use and sick leave. Random-effects meta-analyses were performed using restricted maximum likelihood estimation. Risk of bias was assessed using RoB 2 and ROBINS-I, and certainty of evidence using GRADE. RESULTS: Eleven studies comprising 1154 patients (surgical: 522; nonoperative: 632) were included. Surgery was not associated with superior outcomes in VAS for arm pain (MD: -0.67, 95% CI: -1.59 to 0.26, P =0.12), VAS for neck pain (MD: -0.50, 95% CI: -1.38 to 0.38; P =0.19), or NDI (MD: -3.69, 95% CI: -9.63 to 2.25, P =0.16) after 12 months of treatment, nor in overall success (RR: 1.11, 95% CI: 0.93-1.34, P =0.21). No significant differences were observed in analgesia use ( P =0.54) or sick leave ( P =0.48) at last follow-up. Most studies were rated serious risk of bias and overall certainty of evidence was moderate. CONCLUSION: Evidence from this pooled analysis suggests that long-term pain, disability, and functional outcomes are comparable between patients selected for nonoperative management and those selected for surgery. These findings reflect outcomes within selected cohorts and should not be interpreted as evidence of therapeutic equivalence. LEVEL OF EVIDENCE: Level II.

Humans↗

PubMedDate not supplied

The relationship between social support and adolescent mothers' interactions with their infants: a meta-analysis.

OBJECTIVE: The purpose of this meta-analysis was to statistically summarize the results of independent quantitative studies regarding the relationship between social support and adolescent mothers' interactions with their infants. DATA SOURCES: The following sources were selected from 1980 to 1999: citations from bibliographies of previously located articles, dissertations abstracts, the Social Sciences Citation Indexes, and researchers at a regional conference; online sources used were CINHAL, MEDLINE, ERIC, Psych Lit, and Social Work Abstracts. STUDY SELECTION: Of a potential sample of 31 studies, 14 were excluded because they did not meet the sampling criteria, and 4 were deleted as outliers. The final sample consisted of 13 studies. DATA EXTRACTION: Each study was coded for methodologic and substantive variables, including quality indicators. DATA SYNTHESIS: Most of the studies were cross sectional in design and used a variety of measures. Together, the studies included a sample of 823 mothers. CONCLUSIONS: A medium effect size and a significant relationship between social support of adolescent mothers and their interactions with their infants were established. No difference was found in the relationship when support was provided by the family or through a network.

Adolescent↗

PubMed1996

Psychosocial interventions for patients with coronary artery disease: a meta-analysis.

BACKGROUND: Narrative review strategies and meta-analyses have shown that drug treatment and exercise rehabilitation regimens can reduce psychological distress and postmyocardial infarction mortality and recurrence. OBJECTIVE: To question whether the addition of psychosocial interventions improves the outcome of a standard rehabilitation regimen for patients with coronary artery disease. METHODS: We performed a statistical meta-analysis of 23 randomized controlled trials that evaluated the additional impact of psychosocial treatment of rehabilitation from documented coronary artery disease. Anxiety, depression, biological risk factors, mortality, and recurrence of cardiac events were the clinical end points that were studied. Mortality data were available from 12 studies, and recurrence data were available from 10 of the 23 studies. RESULTS: The studies had evaluated 2024 patients who received psychosocial treatment vs 1156 control subjects. The psychosocially treated patients showed greater reductions in psychological distress, systolic blood pressure, heart rate, and cholesterol level (with effect size differences of -0.34 [corrected], -0.24, -0.38, and -1.54, respectively). Patients who did not receive psychosocial treatment showed greater mortality and cardiac recurrence rates during the first 2 years of follow-up with log-adjusted odds ratios of 1.70 for mortality (95% confidence interval [CI], 1.09 to 2.64) and 1.84 for recurrence (CI, 1.12 to 2.99). CONCLUSIONS: The addition of psychosocial treatments to standard cardiac rehabilitation regimens reduces mortality and morbidity, psychological distress, and some biological risk factors. The benefits were clearly evident during the first 2 years and were weaker thereafter. At the clinical level, it is recommended to include routinely psychosocial treatment components in cardiac rehabilitation. The findings also suggest an urgent need to identify the specific, most effective types of psychosocial interventions via controlled research.

Coronary Disease↗