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PubMed2026

Frequency of Human Brucellosis Complications in West Asia: A Systematic Review and Meta-Analysis.

BACKGROUND: Brucellosis is a multi-systemic zoonotic infection. The West Asia/Middle East region is an important global hotspot for brucellosis. This systematic review and meta-analysis aimed to aggregate and synthesize all the available evidence regarding the complications of brucellosis in West Asia/Middle East region. METHODS: PubMed, Embase, Scopus, Web of Science, Google Scholar, and Proquest were searched. Selection of studies, data extraction, and the risk of bias assessment were performed in duplicate. Data extraction was performed for 254 complications. Meta-analysis was performed using a random-effects model with Freeman-Tukey double arcsine transformation. Where applicable small-study effects was assessed using funnel plots and Egger's test. Separate by-country, by-age, and by-publication-decade subgroup analyses were performed if feasible. RESULTS: Out of 9518 results, 240 studies (260 references) were included. The majority of the included studies were conducted in Turkey (n = 177). The reported complications varied and different complication categorization systems were detected. The highest pooled estimate was observed for musculoskeletal involvement (50%, 95%CI: 39%-61%, I2 = 96.63%). The evidences is up-to-date until March 4, 2024. CONCLUSIONS: Some complications such as the complications of the eye were not reported in all the countries. Therefore, it's recommended to determine the relative frequency of those complications in regions without such reports. The pooled estimates of different complications of brucellosis were different. There's a need for the standardization of the reporting of the complications of brucellosis to achieve comparability between studies and across different regions.

Brucellosis↗

PubMed2004

The use of enamel matrix derivative in the treatment of periodontal defects: a literature review and meta-analysis.

BACKGROUND: Periodontal disease results in the loss of the attachment apparatus. In the last three decades, an increasing effort has been placed on seeking procedures and materials to promote the regeneration of this tissue. The aim of this paper is to evaluate the effect of enamel matrix derivative (EMD) during regenerative procedures. In addition, a meta-analysis is presented regarding the clinical results during regeneration with EMD, to gain evidence as to what can be accomplished following treatment of intrabony defects with EMD in terms of probing depth reduction, clinical attachment level gain, defect fill (using re-entry studies), and radiographic parameters. METHODS: The review includes in vitro and in vivo studies as well as human case reports, clinical comparative trials, and histologic findings. In addition, a meta-analysis is presented regarding the regenerative clinical results. For this purpose, we used 28 studies-including 955 intrabony defects treated with EMD that presented baseline and final data on probing depth, clinical attachment level (CAL) gain, or bone gain-to calculate weighted mean changes in the different parameters. The selected studies were pooled from the MEDLINE database at the end of May, 2003. RESULTS: The meta-analysis of intrabony defects treated with EMD resulted in a mean initial probing depth of 7.94 +/- 0.05 mm that was reduced to 3.63 +/- 0.04 mm (p = 0.000). The mean clinical attachment level changed from 9.4 +/- 0.06 mm to 5.82 +/- 0.07 mm (p = 0.000). These results were significantly better than the results obtained for either open-flap debridement (OFD) or guided tissue regeneration (GTR). In contrast, histologically, GTR is more predictable than EMD in terms of bone and cementum formation. No advantage was found for combining EMD and GTR. Xenograft, or EMD and xenograft, yielded inferior results compared with EMD alone, but a limited number of studies evaluated this issue. Promising results were noted for the combination of allograft materials and EMD. CONCLUSIONS: EMD seems to be safe, was able to regenerate lost periodontal tissues in previously diseased sites based on clinical parameters, and was better than OFD or GTR. Its combination with allograft materials may be of additional benefit but still needs to be further investigated.

Animals↗

PubMed1997

Alprazolam and standard antidepressants in the treatment of depression: a meta-analysis of the antidepressant effect.

Alprazolam differs from other benzodiazepines by the incorporation of a triazolo ring in the basic chemical structure. Several lines of evidence have supported that alprazolam and standard antidepressants have some similar actions, such as beta-adrenergic receptor down-regulation, antipanic effect. Because of the difference in opinions pertaining to the antidepressant effect of alprazolam, this issue could not reach a firm conclusion. In the present analysis, we carried out a meta-analysis of 11 random controlled studies that compared the antidepressant effect of alprazolam and standard antidepressants in depressed patients. The results showed that the weighted mean effect size d (dw) is equal to 0.06. In conclusion, the antidepressant effect of alprazolam is comparable to that of low-dose tricyclic antidepressants. Very few studies have investigated severely depressed patients. Also, in long-term administration, the lack of a long-term treatment study makes the issue of alprazolam's benefits and disadvantages still undetermined.

Alprazolam↗

PubMed2006

The effect of carvedilol on mortality risk in heart failure patients with diabetes: results of a meta-analysis.

BACKGROUND: Although beta-blocker therapy has been shown to improve survival in patients with chronic heart failure, this class of drugs tends to be underutilized in diabetic patients due to concerns about adverse metabolic effects, especially on glycemic control. No randomized clinical trial has specifically evaluated the effect of beta-blocker therapy on mortality in diabetic patients with heart failure. Previous meta-analyses combining results of heart failure trials with pharmacologically diverse beta-blockers suggest that the survival benefit in diabetic patients may be diminished compared to benefits in non-diabetic patients. However, some trial results indicate that carvedilol, which blocks beta1-, beta2-, and alpha1-receptors and is a potent antioxidant, may produce at least comparable effects in both patient groups. OBJECTIVES: To evaluate the effect of carvedilol in patients with heart failure and diabetes, specifically to determine if the survival benefit of carvedilol demonstrated in heart failure trials was as great in the subgroups of patients with diabetes. METHODS: A meta-analysis was performed that included 5757 patients with heart failure, 25% of whom had diabetes, from seven large placebo-controlled randomized trials with carvedilol. All large (> 100 patients) placebo-controlled, randomized trials with carvedilol in heart failure were included. The endpoint of all-cause mortality was examined in the overall population, patients without diabetes, and patients with diabetes. The number of patients needed to treat (NNT) for 1 year to prevent one death associated with carvedilol use in diabetic versus non-diabetic patients was also calculated. The log-rank test and the Cox proportional hazards regression were used to compare the event time distributions of carvedilol versus placebo with respect to the outcome of mortality. RESULTS: Similar survival benefits were seen with carvedilol use in diabetic and non-diabetic patients (relative risk reductions of 28% [95% confidence interval (CI) 3-46%; p = 0.03] and 37% [95% CI 22-48%; p < 0.001], respectively). There were no significant differences between the relative mortality risk reductions or the NNT with carvedilol use in diabetic versus non-diabetic patients. The NNT for 1 year to prevent one death was 23 for all patients, as well as for non-diabetic patients, and 25 for the diabetic group. CONCLUSIONS: This meta-analysis provides evidence that the same survival benefit may occur with carvedilol in heart failure patients with and without diabetes. The low NNT in the severe heart failure trial, COPERNICUS, and the diabetic subgroup in this meta-analysis suggests that severe heart failure patients and heart failure patients with diabetes may particularly derive benefit from therapy with carvedilol.

Aged↗

PubMed2003

Detection of feigned mental disorders: a meta-analysis of the MMPI-2 and malingering.

The validity of test data from multiscale inventories is dependent on self-reports that may be easily distorted by malingering. In examining the Minnesota Multiphasic Personality Inventory-2's (MMPI-2) role in the assessment of feigning, this review provides a conceptual analysis of the detection strategies underlying the MMPI-2 validity scales. The conceptual analysis is augmented by comprehensive meta-analysis of 65 MMPI-2 feigning studies plus 11 MMPI-2 diagnostic studies. For the rare-symptoms strategy, Fp (Cohen's d = 2.02) appears especially effective across diagnostic groups; its cut scores evidence greater consistency than most validity indicators. The data supported the F as an effective scale but questioned the routine use of Fb. Among the specialized scales, Ds appeared especially useful because of its sophisticated strategy, consistent cut score, and minimalfalse-positives. General guidelines are offeredfor specific MMPI-2 validity scales in the assessment of malingering with specific diagnoses.

Factitious Disorders↗

PubMed1995

A meta-analysis of randomized, double-blind, placebo-controlled studies of the effect of buflomedil on intermittent claudication.

A meta-analysis was performed on the results of clinical trials of buflomedil in intermittent claudication. The analysis used results from 744 patients enrolled in ten studies, conducted at 42 centers in seven countries. All studies were randomized, double-blind, placebo-controlled trials which measured improvement in "pain-free" walking distance by treadmill ergometry as the primary measure of efficacy. The meta-analysis results were based on "effect size", a standardized difference in mean response between buflomedil and placebo. Results demonstrated a statistically superior response to buflomedil compared with placebo, indicating that the average buflomedil treated patient was likely to have a greater improvement in walking distance than at least 60% of the placebo treated patients. Results were corroborated using various weighting schemes proportional to study quality ratings and sample sizes.

Double-Blind Method↗

PubMed1986

Systems analysis of schools of allied health using Leavitt's Organizational Model: a meta-analysis.

Schools of allied health are relative newcomers to the formal academic setting. Consequently, these new academic units are particularly vulnerable to external threats to survival as they struggle to achieve acceptance by faculty and administrators in the traditional disciplines. This paper describes an application of Leavitt's Organizational Model for systems analysis of schools of allied health. A meta-analysis of studies reported in the Journal of Allied Health was conducted to provide administrative insight for the model's dimensions of task, structure, technology, and people. The model is helpful in organizing information and predicting effects of intervention strategies when any single dimension is changed. By viewing schools of allied health from a holistic perspective, deans and chair persons can anticipate the effect of change on variables (dimensions) other than those being manipulated and weight intervention strategies before their adoption.

Humans↗

PubMed2004

Beyond classical meta-analysis: can inadequately reported studies be included?

Classical meta-analysis requires the same data from each clinical trial, thus data-reporting must be of a high-quality. Imputation methods are used to include studies that provide incomplete information on variability and the fixed and random effects of a drug. Regression models can be used to include studies other than randomized placebo-controlled studies. In the example outlined here, the use of non-randomized single-arm studies and studies against comparator treatments has little influence on the estimation of the treatment effect in comparison with placebo, an effect that is based on the randomized placebo-controlled studies. The inclusion of other studies serves to increase the precision of the effect of the treatment compared with baseline. Although multiple imputation techniques enable a larger number of studies to be included, which will typically increase the precision of the estimated effect, a careful sensitivity analysis is also required.

Clinical Trials as Topic↗

PubMed2006

Association study of serotonin 2A receptor (5-HT2A) gene with schizophrenia and suicidal behavior using systematic meta-analysis.

Serotonin 2A receptor (5-HT2A) gene was implicated to be associated with both schizophrenia and suicidal behavior due to its role of key neurotransmitter in many physiologic processes. Association studies were reported in different populations, however, a great number of subsequent studies have produced contrary results, possibly reflecting inadequate statistical power. With the cumulative data in recent years in both European and Asian populations, particularly in Asian populations, it was necessary to carry out a comprehensive analysis of previous findings. The meta-analysis, therefore, combined all English and Chinese studies using multiple research methods published up to July 2005 to give a new picture of the role of the 5-HT2A gene. Compared with significant results reported previously, the current large samples (73 studies in all) failed to find significant association of the T102C polymorphism with either schizophrenia or suicidal behavior. Evidence of significant association was only detected between A-1438G and suicidal behavior. The current study did not support the association of the 5-HT2A gene with either schizophrenia or suicidal behavior.

Alleles↗

PubMed1997

Study of situation-dependent clinical cognition: a meta-analysis and preliminary method.

An integrated method was constructed for the study of in situ clinical reasoning. A meta-analysis of existing theories and an exploratory case study were performed. Twelve physicians at the department of otorhinolaryngology, and three physicians and three biomedical technologists at the clinical microbiological laboratory of an 800-bed university hospital were involved in the evaluation of the method. The meta-analysis identified situations where practitioners face assignments for which they follow no routine strategy as suitable starting points for the development of the method, in which organizational processes are presented as workflow graphs. Using the critical incident technique, problem situations in the processes are identified, and stimulated recall interviews are employed to construct a model of the situation-dependent logic used in decision-making. The case study showed that the first levels of the method could easily be used by physicians without training in organizational development or cognitive psychology. It is concluded that the method can be a means for case construction in problem-oriented learning programs that have an empirical background. It can also be used in the development of clinical organization, where training is combined with the establishment of critical paths and computer support.

Algorithms↗

PubMed2007

Association study between the NMDA receptor 2B subunit gene (GRIN2B) and schizophrenia: a HuGE review and meta-analysis.

Schizophrenia is a severe mental illness to which hypofunction of the N-methyl-D-aspartate receptors has been linked. Association studies have implicated the N-methyl-D-aspartate receptor 2B subunit gene (GRIN2B) as a candidate for schizophrenia. Subsequent studies have attempted to replicate the association, but the results have been mixed and thus inconclusive. It is necessary to explain the inconsistency of these results and to clarify the contribution of the GRIN2B gene to schizophrenia. The current meta-analysis covers all published association studies up to January 2006 using systematic allelic and genotypic analyses involving five polymorphisms. The results show evidence of a statistically significant association for GRIN2B. The association seems weaker, but nonetheless interesting. The meta-analysis supports the involvement of the glutamate system of the brain in the pathogenesis of schizophrenia. This may be the first systematic meta-analysis study focusing on GRIN2B.

Case-Control Studies↗

PubMed1990

A meta-analysis of subjective well-being interventions among elders.

This meta-analysis demonstrated that interventions have a significant (p less than .05) immediate posttreatment influence on elders' subjective well-being but that their beneficial effect dissipates within 1 month. For 28 effect sizes derived from immediate posttreatment occasions (delay = 0 days), the median value was 0.67. Immediate posttreatment effect sizes for control enhancement (M = 1.12), psychoeducational (M = 0.70), and social activity (M = 0.66) treatments were significantly (p less than .05) above zero and not significantly different from each other. In contrast, for 17 effect sizes derived from delayed posttest occasions (delay greater than 0 days), the median value was 0.07. For effect sizes extracted from studies with both an immediate and a delayed posttest, the mean decrease over a 30-day period was 1.02.

Adaptation, Psychological↗

PubMed2001

A comprehensive meta-analysis of the predictive validity of the graduate record examinations: implications for graduate student selection and performance.

This meta-analysis examined the validity of the Graduate Record Examinations (GRE) and undergraduate grade point average (UGPA) as predictors of graduate school performance. The study included samples from multiple disciplines, considered different criterion measures, and corrected for statistical artifacts. Data from 1,753 independent samples were included in the meta-analysis, yielding 6,589 correlations for 8 different criteria and 82,659 graduate students. The results indicated that the GRE and UGPA are generalizably valid predictors of graduate grade point average, 1st-year graduate grade point average, comprehensive examination scores, publication citation counts, and faculty ratings. GRE correlations with degree attainment and research productivity were consistently positive; however, some lower 90% credibility intervals included 0. Subject Tests tended to be better predictors than the Verbal, Quantitative, and Analytical tests.

Adult↗

PubMed2026

Effects of dietary interventions on gut microbiota and related cardiometabolic changes in pediatric obesity: a systematic review and meta-analysis.

BACKGROUND: Gut microbiota imbalances may contribute to obesity, yet whether dietary interventions can modulate the microbiota and improve metabolic health in pediatrics has not been thoroughly reviewed. This systematic review and meta-analysis explores the impact of dietary interventions on the gut microbiota of children and adolescents with overweight or obesity, and its association with cardiometabolic improvements. METHODS: A systematic search of clinical trials in Pubmed, Cochrane and EMBASE was conducted following PRISMA guidelines (PROSPERO n°CRD42024505494). Risk of bias was assessed with RoB2 and ROBINS, for randomized and non-randomized intervention studies. RESULTS: Overall, 60 articles were assessed for full-text eligibility, 8 were included, and 4 provided alpha-diversity data for meta-analysis. A total of 200 participants were included (6-16 years). Six studies implemented calorie-restricted diets, one a low free-sugar diet, and one CHILD-1 diet. The meta-analysis revealed a significant increase in Chao1 (48.76 [95%CI 1.81; 95.70]; I2 = 86.8%, p < 0.001) following a balanced calorie-restricted dietary intervention. Although there was heterogeneity in taxa-level changes, several butyrate-producing genera (Clostridium XVIa, Coprococcus, Roseburia, Faecalibacterium, Blautia, Butyricimonas) increased following dietary intervention. CONCLUSIONS: Balanced dietary interventions with calorie-restriction adequate for pediatric age could increase gut microbiota richness and butyrate-producing bacteria abundance. Future trials should clarify diet-driven gut microbiota changes in childhood obesity and related metabolic changes. IMPACT: Balanced calorie restriction diet may increase gut microbiota richness in childhood obesity Butyrate-producer expansion needs long-term dietary intervention Gaps in linking microbiota-metabolism interplay in pediatric obesity.

Journal Article↗

PubMed2026

The Addition of Concurrent Immune Checkpoint Inhibitors for Chemoradiotherapy With Consolidative Immune Checkpoint Inhibitors in Unresectable Cancers: A Systematic Review and Meta-Analysis.

Following the success of chemoradiotherapy (CRT) combined with consolidative immune checkpoint inhibitors (ICIs) in locally advanced tumors, over 30 ongoing randomized controlled trials (RCTs) are investigating the potential benefits of adding concurrent ICIs. To investigate the differences in efficacy and safety between adding and not adding concurrent ICIs to CRT followed by consolidative ICIs, a literature search was conducted in PubMed, Embase, and the Cochrane Library, incorporating RCTs comparing CRT combined with consolidative ICIs versus CRT alone, or CRT with both concurrent and consolidative ICIs versus CRT alone. The primary outcomes were overall survival (OS) and progression-free survival (PFS). To reduce potential bias, an additional mirror-design analysis was performed through network meta-analysis. A total of 13 RCTs comprising 6868 patients and 14 cohort studies comprising 4724 patients were included. While patients treated with CRT and consolidative ICIs demonstrated significantly superior OS and PFS to patients treated with CRT alone in RCTs (HR of OS, 0.743, 95% CI, 0.654-0.843; HR of PFS, 0.674, 95% CI, 0.577-0.786), CRT and concurrent-plus-consolidative ICIs did not improve OS and PFS compared with CRT alone (HR of OS, 0.942, 95% CI, 0.782-1.134; HR of PFS, 0.880, 95% CI, 0.752-1.030). Significant differences were detected in OS (p = 0.038) and PFS (p = 0.017) between CRT combined with consolidative ICIs treatment versus CRT combined with concurrent and consolidative ICIs treatment from RCTs. In conclusion, adding concurrent ICIs may dampen the survival benefits of CRT combined with consolidative ICIs. This evidence informs future RCT design strategies.

Humans↗

PubMed2006

A randomized trial of tranexamic acid in combination with cell salvage plus a meta-analysis of randomized trials evaluating tranexamic acid in off-pump coronary artery bypass grafting.

OBJECTIVES: We sought to evaluate the effectiveness of tranexamic acid in off-pump coronary artery bypass grafting surgery, either when used in combination with mechanical cell salvage or when used alone. METHODS: One hundred patients were randomized to either 2 g of tranexamic acid as an intravenous bolus before sternotomy or to placebo. Intraoperative and postoperative cell salvage was used in all patients. The primary end point was early postoperative blood loss (within 4 hours). To evaluate the efficacy of tranexamic acid in isolation, we also performed a meta-analysis of 4 randomized trials identified from a systematic literature search. The primary end point of the meta-analysis was red cell transfusion. RESULTS: In our randomized trial patients in the tranexamic acid group had a significant reduction in early postoperative blood loss, (median difference, 50 mL; 95% confidence interval, 15-100 mL; P < .01); however, there was no reduction in the frequency of blood component transfusion. Patients in the placebo group received a significantly larger volume of autotransfused red cells (median difference, 120 mL; 95% confidence interval, 0-220 mL; P = .02). The meta-analysis demonstrated a significant reduction in red cell transfusions in patients receiving tranexamic acid compared with those receiving placebo (risk ratio, 0.48; 95% confidence interval, 0.24-0.97; P = .041). There was also a reduction in the frequency of any allogeneic blood component transfusion, as well as a highly significant reduction in postoperative blood loss, in patients receiving tranexamic acid (P < .001). CONCLUSIONS: Tranexamic acid reduces blood loss and transfusion requirements in off-pump coronary artery bypass grafting surgery. A reduction in allogeneic blood transfusion was not evident in the presence of perioperative cell salvage. These data support the routine use of tranexamic acid in off-pump coronary artery bypass grafting surgery.

Adult↗

PubMedDate not supplied

A meta-analysis of fall prevention programs for the elderly: how effective are they?

BACKGROUND: Although fall prevention studies for the elderly have been reported, there is a paucity of work summarizing the effectiveness of these interventions. OBJECTIVES: The research question that guided this study was: 'What are the effects of fall prevention programs on the proportion of falls in the elderly?" METHOD: Meta-analysis was employed to summarize findings of intervention studies of fall prevention in the elderly involving a comparison group and a quantifiable outcome. Studies were reviewed by two of the authors with the eligibility criteria in mind. Studies were then coded and an inter-rater reliability check was performed. RESULTS: The overall mean weighted effect size for the 12 studies included in the meta-analysis was .0779 (Z = 5.03, p < .001). For fall prevention intervention types, exercise alone had a mean weighted effect size of .0220 (Z = .5303, p > .5), exercise and risk modification had a mean weighted effect size of .0687 (Z = 3.41, p < .001), and comprehensive risk assessment intervention studies had an effect size of .1231 (Z = 3.97, p < .001). The mean weighted effect size size for community-based studies was .0972 (Z = 5.37, p < .001) and for institution-based studies was .0237 (Z = .7822, p = .22). Time to outcome measure analyses revealed that the mean weighted effect size for studies measuring proportion of falls at 12 months was .0905 (Z = 5.43, p < .001), and those measuring at four months or less was -.0972 (Z = -.005, p > .50). CONCLUSIONS: The results of this meta-analysis indicate that there was a 4% decrease in the rate of falls for individuals who were in the treatment groups receiving various fall prevention interventions. Additional intervention studies need to be conducted in the elderly population with a goal of preventing falls.

Accidental Falls↗

PubMed1993

Efficacy and safety of Clivarin and other LMWHs in general surgery: a meta-analysis.

Low molecular weight heparin (LMWH) represents the most recent significant development in antithrombotic therapy. A number of meta-analyses of randomized double-blind and open studies of thromboprophylaxis in surgery have been reported recently. Standardized approaches for the diagnosis of efficacy parameters (deep vein thrombosis (DVT) and pulmonary embolism (PE)) have been used in those studies. However, the assessment of safety has varied considerably. In none of these meta-analyses has a homogeneous marker of bleeding risk such as wound haematoma been analysed. In theory, the dose of heparin used should affect safety as well as efficacy. Therefore, we performed a meta-analysis in which the efficacy and an objective assessment of safety in relation to the dose of heparin administered. The dose was standardized relative to the recently established first International Standard for LMWH. On-line literature searches in Medline, EMBASE, Biosis and Ringdoc databases identified 16 randomly allocated trials, of LMWH vs UFH, of high level of methodology which were included in the meta-analysis. The incidence and odds ratios (OR) in relation to the administered dose for DVT and for wound haematoma were recorded. The cut-off point of 3,400 IU aXa was found to be the currently highest recommended dose of LMWH for prophylaxis of thromboembolism in general surgery. The analysis of efficacy (DVT) of all trials gave an OR of -0.79, CI 0.63-0.99. The safety analysis (wound haematoma) of all trials gave an OR 1.03, CI 0.84-1.27.(ABSTRACT TRUNCATED AT 250 WORDS)

Dose-Response Relationship, Drug↗