As reported by Hope S. Rugo, MD, and John W. Park, MD, both of the University of California, San Francisco, and colleagues in The New England Journal of Medicine, the multiarm adaptive randomization phase II I-SPY 2 trial has shown that the addition of veliparib/carboplatin and the addition of neratinib to standard neoadjuvant therapy have met criteria predictive of success in a phase III trial of the same comparators in early breast cancer patients with specific biomarker signatures.1,2. I-SPY 2 Details. In the I-SPY 2 trial, multi-arm adaptive randomization is being used to evaluate the effectiveness of multiple new agents added to standard neoadjuvant chemotherapy in producing pathologic complete response in high-risk stage II to III breast cancer based on biomarker subtypes. The aim of the multi-arm adaptive randomization scheme is to more rapidly and accurately identify experimental regimens with a higher likelihood of success in phase II trials that can include smaller numbers of ...
BACKGROUND: Adults in intensive care units (ICUs) often suffer from a lack of sleep or frequent sleep disruptions. Non-pharmacological interventions can improve the duration and quality of sleep and decrease the risk of sleep disturbance, delirium, post-traumatic stress disorder (PTSD), and the length of stay in the ICU. However, there is no clear evidence of the effectiveness and harms of different non-pharmacological interventions for sleep promotion in adults admitted to the ICU. OBJECTIVES: To assess the efficacy of non-pharmacological interventions for sleep promotion in critically ill adults in the ICU.To establish whether non-pharmacological interventions are safe and clinically effective in improving sleep quality and reducing length of ICU stay in critically ill adults.To establish whether non-pharmacological interventions are cost effective. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 6), MEDLINE (OVID, 1950 to June 2014), EMBASE ...
© 2017 Tucker et al. Background: Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension. Methods and findings: Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised
Introduction: Self-monitoring of blood pressure is effective in reducing blood pressure in hypertension. However previous meta-analyses have shown a considerable amount of heterogeneity between studies, only part of which can be accounted for by meta-regression. This may be due to differences in design, recruited populations, intervention components or results among patient subgroups. To further investigate these differences, an individual patient data (IPD) meta-analysis of self-monitoring of blood pressure will be performed. Methods and analysis: We will identify randomised trials that have compared patients with hypertension who are self-monitoring blood pressure with those who are not and invite trialists to provide IPD including clinic and/or ambulatory systolic and diastolic blood pressure at baseline and all follow-up points where both intervention and control groups were measured. Other data requested will include measurement methodology, length of followup, cointerventions, baseline demographic
Although the effects of physical fitness training on death, dependence, and disability after stroke are unclear, there is sufficient evidence to incorporate cardiorespiratory training that involves walking within poststroke rehabilitation programs to improve speed, tolerance, and independence during walking, say authors of a meta-analysis published in November in the Cochrane Database of Systematic Reviews. The authors searched the Cochrane Stroke Group Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, SPORTDiscus, and 5 additional databases. They also searched ongoing trials registers, handsearched relevant journals and conference proceedings, screened reference lists, and contacted experts in the field.. Selection criteria included randomized trials comparing either cardiorespiratory training or resistance training, or both, with no intervention, a nonexercise intervention, or usual care in stroke survivors. Two review authors independently selected ...
Granulocyte colony stimulating factor (G-CSF) may enhance recovery from stroke through neuroprotective mechanisms if administered early, or neurorepair if given later. Several small trials suggest administration is safe but effects on efficacy are unclear. We searched for randomised controlled trials (RCT) assessing G-CSF in patients with hyperacute, acute, subacute or chronic stroke, and asked Investigators to share individual patient data on baseline characteristics, stroke severity and type, end-of trial modified Rankin Scale (mRS), Barthel Index, haematological parameters, serious adverse events and death. Multiple variable analyses were adjusted for age, sex, baseline severity and time-to-treatment. Individual patient data were obtained for 6 of 10 RCTs comprising 196 stroke patients (116 G-CSF, 80 placebo), mean age 67.1 (SD 12.9), 92% ischaemic, median NIHSS 10 (IQR 5-15), randomised 11 days (interquartile range IQR 4-238) post ictus; data from three commercial trials were not shared. ...
Objectives: To assess the accuracy in diagnosing heart failure of clinical features and potential primary care investigations, and to perform a decision analysis to test the impact of plausible diagnostic strategies on costs and diagnostic yield in the UK health-care setting. Data sources: MEDLINE and CINAHL were searched from inception to 7 July 2006. Grey literature databases and conference proceedings were searched and authors of relevant studies contacted for data that could not be extracted from the published papers. Review methods: A systematic review of the clinical evidence was carried out according to standard methods. Individual patient data (IPD) analysis was performed on nine studies, and a logistic regression model to predict heart failure was developed on one of the data sets and validated on the other data sets. Cost-effectiveness modelling was based on a decision tree that compared different plausible investigation strategies. Results: Dyspnoea was the only symptom or sign with high
BACKGROUND: Randomized trials without reported adequate allocation concealment have been shown to overestimate the benefit of experimental interventions. We investigated the robustness of conclusions drawn from meta-analyses to exclusion of such trials. MATERIAL: Random sample of 38 reviews from The Cochrane Library 2003, issue 2 and 32 other reviews from PubMed accessed in 2002. Eligible reviews presented a binary effect estimate from a meta-analysis of randomized controlled trials as the first statistically significant result that supported a conclusion in favour of one of the interventions. METHODS: We assessed the methods sections of the trials in each included meta-analysis for adequacy of allocation concealment. We replicated each meta-analysis using the authors methods but included only trials that had adequate allocation concealment. Conclusions were defined as not supported if our result was not statistically significant. RESULTS: Thirty-four of the 70 meta-analyses contained a mixture of
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Our present results are similar to the latest Cochrane review by Cooney et al, 24 who found a moderate effect of exercise on depressive symptoms (−0.62 SMD) when including all trials and no effect when restricting the analysis to trials with less risk of bias (−0.18 SMD). The Cochrane review did find evidence of a small antidepressant effect beyond the intervention, which we could not confirm in our present systematic review. Bridle et al 13 included nine trials allocating old (,60 years) participants with depression to exercise interventions versus control interventions. Restricting the analysis to four trials at lower risk of bias they found small-to-moderate effect estimates (SMD −0.34) in favour of exercise. The studies by Cooney et al 24 and Bridle et al 13 both included trials allocating participants with depressive symptoms and not necessarily diagnosed using a validated diagnostic system, potentially explaining the differences in the effect sizes. However, in our present systematic ...
The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified. A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data. Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976-1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) ...
Many key RCT methods were not used or not reported. Adequate allocation concealment, adequate double-blinding, and intention-to-treat analysis were reported in only 50% of the trials. These findings suggest that there is much room for improvement in respiratory RCTs. However, improvement was found in the COPD RCTs, in which there was adequate allocation sequence generation, adequate allocation concealment, and intention-to-treat analysis in 27.0%, 11.6%, and 21.8%, respectively.8 Registered trials, trials cited ≥ 10 times, trials in journals with impact factor ≥ 5, and trials in the general medical journals were more likely to be of adequate methodological quality.. Important aspects of RCT methodology, such as randomization methods, allocation concealment, blinding, and sample-size calculation, are commonly inadequate in RCTs.12 That was the reason we conducted the analysis: to find the related facts on these methodological items. We decided to include trials published in leading journals ...
BACKGROUND: Insomnia is a widespread complaint in the general population. Wendan decoction has been widely applied in the treatment of primary insomnia. However, to our knowledge, there has been no systematic review or meta-analysis of randomized controlled trails regarding the effectiveness of this treatment. Here, we provide a protocol to evaluate the efficacy and safety of Wendan decoction for primary insomnia. METHODS AND ANALYSIS: Relevant randomized controlled trials in 5 English databases [EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane Library), PubMed, the Allied and Complementary Medicine Databases (AMED), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)], 4 Chinese databases [Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), China National Knowledge Infrastructure (CNKI), and Wanfang Database] will be comprehensively searched by 2 researchers in October 2017 ...
OBJECTIVES: To survey the frequency of use of indirect comparisons in systematic reviews and evaluate the methods used in their analysis and interpretation. Also to identify alternative statistical approaches for the analysis of indirect comparisons, to assess the properties of different statistical methods used for performing indirect comparisons and to compare direct and indirect estimates of the same effects within reviews. DATA SOURCES: Electronic databases. REVIEW METHODS: The Database of Abstracts of Reviews of Effects (DARE) was searched for systematic reviews involving meta-analysis of randomised controlled trials (RCTs) that reported both direct and indirect comparisons, or indirect comparisons alone. A systematic review of MEDLINE and other databases was carried out to identify published methods for analysing indirect comparisons. Study designs were created using data from the International Stroke Trial. Random samples of patients receiving aspirin, heparin or placebo in 16 centres were used
Publication bias has long been associated with funnel plot asymmetry.10 Among published studies, however, the probability of identifying relevant trials for meta-analysis is also influenced by their results. English language bias-the preferential publication of negative findings in journals published in languages other than English-makes the location and inclusion of such studies less likely.8 As a consequence of citation bias, negative studies are quoted less frequently and are therefore more likely to be missed in the search for relevant trials.7 36 Results of positive trials are sometimes reported more than once, increasing the probability that they will be located for meta-analysis (multiple publication bias).37 These biases are likely to affect smaller studies to a greater degree than large trials.. Another source of asymmetry arises from differences in methodological quality. Smaller studies are, on average, conducted and analysed with less methodological rigour than larger studies. ...
Publication bias has long been associated with funnel plot asymmetry.10 Among published studies, however, the probability of identifying relevant trials for meta-analysis is also influenced by their results. English language bias-the preferential publication of negative findings in journals published in languages other than English-makes the location and inclusion of such studies less likely.8 As a consequence of citation bias, negative studies are quoted less frequently and are therefore more likely to be missed in the search for relevant trials.7 36 Results of positive trials are sometimes reported more than once, increasing the probability that they will be located for meta-analysis (multiple publication bias).37 These biases are likely to affect smaller studies to a greater degree than large trials.. Another source of asymmetry arises from differences in methodological quality. Smaller studies are, on average, conducted and analysed with less methodological rigour than larger studies. ...
BACKGROUND: Gestational weight gain is positively associated with fetal growth, and observational studies of food supplementation in pregnancy have reported increases in gestational weight gain and fetal growth.. OBJECTIVES: To assess the effects of education during pregnancy to increase energy and protein intake, or of actual energy and protein supplementation, on energy and protein intake, and the effect on maternal and infant health outcomes.. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Groups Trials Register (31 January 2015), reference lists of retrieved studies and contacted researchers in the field.. SELECTION CRITERIA: Randomised controlled trials of dietary education to increase energy and protein intake, or of actual energy and protein supplementation, during pregnancy.. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion and assessed risk of bias. Two review authors independently extracted data and checked for accuracy. ...
This study is designed to provide clear evidence for health and social policymakers about the influence of alternate service-delivery models and practices on enhancing and sustaining low-income family linkages to available services. A challenge faced by Canadian health and social service providers is to promote health for low-income families in a proactive and cost-effective manner. Families with low incomes experience an array of health and social barriers that compromise their resilience, lead to negative family outcomes, and act as barriers to available services. Family barriers are compounded by service delivery barriers and result in reduced opportunities for effective, primary-level services and in increased use of secondary-level services (e.g., emergency room visits, emergency intervention, police involvement), with the obvious increase in costs. Randomized-controlled trials are rare in community-based intervention research.. This Families First Edmonton randomized-controlled trial (RCT) ...
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Background: DNA-based disease risk information is becoming widely available. Expectations are high that communicating this information motivates behaviour change to reduce risk. Objective: To assess the impact of communicating DNA-based disease risk estimates on risk-reducing health behaviours and motivation to engage in such behaviours. Design: Systematic review with meta-analysis, using Cochrane methods. We assessed risk of bias for each included study and quality of evidence for each behavioural outcome. Data sources: We searched the following databases up to 25th February 2015: MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Controlled Trials. We also conducted backward and forward citation searches. Eligibility criteria for selecting studies: Randomised and quasi-randomised controlled trials involving adults in which one group received personalised DNA-based disease risk estimates for diseases for which the risk could be reduced by behaviour change. Eligible studies included ...
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patients with established coronary artery disease and type-2 diabetes. Brilinta reduced cardiovascular events in patients with no prior heart attack or stroke. The Phase III THEMIS trial met its primary endpoint and demonstrated that Brilinta (ticagrelor), taken in conjunction with aspirin, showed a statistically-significant reduction in a composite of major adverse cardiovascular events (MACE) compared to aspirin alone.. THEMIS was conducted in over 19,000 patients with coronary artery disease (CAD) and type-2 diabetes (T2D) with no prior heart attack (myocardial infarction, MI) or stroke. Preliminary safety results were consistent with the known profile of Brilinta. A full evaluation of the THEMIS data will be presented at a forthcoming medical meeting.. Elisabeth Björk, Senior Vice President, Head of late Cardiovascular, Renal and Metabolism, R&D BioPharmaceuticals, said: Approaches to help reduce cardiovascular morbidity further in patients with coronary artery disease and type-2 diabetes ...
Rivaroxaban and risk of myocardial infarction: insights from a meta-analysis and trial sequential analysis of randomized clinical trials.
In order to avoid selective biases and to minimize random errors, inference about the effects of treatment on serious endpoints needs to be based not on one, or a few, of the available trial results, but on a systematic overview of the totality of the evidence from all the relevant unconfounded randomized trials. But, only where coverage of all, or nearly all, randomized patients in all relevant trials (or a reasonably unbiased sample of such trials) can be assured, is a systematic overview of trials reasonably trustworthy, for then any selective biases are likely to be small in comparison with any moderate effects of treatment. Checks for the existence of such biases can best be conducted if reasonably detailed data are available from each trial. Future trials should take into account the results of any relevant overviews in their design, and should plan to obtain sufficient numbers of events to contribute substantially to such overviews. In many cases, this implies the need for randomized trials that
To summarize data on long-term ipsilateral local recurrence (LR) and breast cancer death rate (BCDR) for patients with ductal carcinoma in situ (DCIS) who received different treatments. Systematic review and study-level meta-analysis of prospective (n = 5) and retrospective (n = 21) studies of patients with pure DCIS and with median or mean follow-up time of ≥10 years. Meta-regression was performed to assess and adjust for effects of potential confounders - the average age of women, period of initial treatment, and of bias - follow-up duration on recurrence- and death-rates in each treatment group. LR and BCDR rates by local treatment used were reported. Outside of randomized trials, remaining studies were likely to have tailored patient treatment according to the clinical situation. Nine thousand four hundred and four DCIS cases in 9391 patients with 10-year follow-up were included. The adjusted meta-regression LR rate for mastectomy was 2.6 % (95 % CI, 0.8-4.5); breast-conserving surgery with
be set to play too loudly. Should all be banned as potentially dangerous? Every practitioner is aware of his/her responsibility to make sure that the device is played at an appropriate level. Basing conclusions on a single, very probably atypical case, is a poor practice-the authors conclusions are not justified.. A good deal of what has been written about AIT is excessively skeptical, negative or derogatory, permeated with the assumption that AIT is ineffective. Our review of all the research on the efficacy of AIT that we have been able to find refutes this negative view.. Probably because AIT lacks a plausible rationale and is counter-intuitive, it has become the target of skepticism and of negatively biased research. Ones opinion about an intervention, like ones opinion about an individual, should be based on evidence rather than prejudice. The present authors were themselves skeptical when first learning about AIT. Their interest was stimulated, despite their initial skepticism, by a ...
Multilevel network meta-regression for population adjustment based on individual and aggregate level data. Abstract: Standard network meta-analysis (NMA) and indirect comparisons combine aggregate data (AgD) from multiple studies on treatments of interest, assuming that any effect modifiers are balanced across populations. We can relax this assumption if individual patient data (IPD) are available from all studies by fitting an IPD meta-regression. However, in many cases IPD are only available from a subset of studies. In the simplest scenario, IPD are available for an AB study but only AgD for an AC study. Methods such as Matching Adjusted Indirect Comparison (MAIC) create a population-adjusted indirect comparison between treatments B and C. However, the resulting comparison is only valid in the AC population without additional assumptions, and the methods cannot be extended to larger treatment networks. Meta-regression-based approaches can be used in larger networks. However, these typically ...
This new Cochrane review looked at school-based interventions aimed at changing behaviour related to toothbrushing habits and the frequency of consumption of cariogenic food and drink in children between the ages of 4 and 12 years. The Cochrane Oral Health Groups Trials Register, and Cochrane Central Register of Controlled Trials (CENTRAL) ,Medline, Embase, CINAHL, PsycINFO, [read the full story…]. ...
Treatment comparisons without head-to-head trials are frequently formed using indirect comparisons across multiple trials, making the assumption that any effect modifiers are balanced between trials. Recently proposed methods which relax this assumption, including Matching-Adjusted Indirect Comparison (MAIC) and Simulated Treatment Comparison (STC), are becoming increasingly common in industry-sponsored treatment comparisons, where a company has individual patient data (IPD) from its own trials but only aggregate data from competitor trials. These methods aim to adjust for between-trial differences to form population-adjusted indirect comparisons, and may even be used for comparisons involving single arm studies or disconnected networks. However, additional assumptions and complexities are introduced which must be carefully considered. Since the premise of population adjustment methods is that relative treatment effects can differ between populations, a core component of population adjustment in ...
As far as I am concerned, discussions around the pros and cons of various methods are perfectly fine, esp. if they are directly linked to implementations in R. So, we are considering two methods: 1) A random-effects model with the standard 1/(vi + tau^2) weights (where vi is the sampling variance of the ith study and tau^2 the (estimated) amount of variance/heterogeneity in the true outcomes) versus 2) A random-effects model with 1/vi weights. Under the assumptions of the RE model and in the absence of publication bias, both approaches provide an unbiased estimate of the average true outcome. Approach 1 is more efficient; in fact, using 1/(vi + tau^2) weights gives us the uniformly minimum variance unbiased estimator (UMVUE). Sidenote: To be precise, that is only true if tau^2 would be a known quantity and not estimated (and similarly, the sampling variances must be known quantities). So, really, we are only getting an approximation to the UMVUE. The larger k (number of studies) is, the more ...
In this course, students will learn about common types of miscommunication and misunderstandings associated with visual representation of data and about best practices for data visualization. Through a series of case studies, students will critically evaluate relevant data, the format of its presentation, and the impact the method of presentation has on the reader. Specifically, through critical analysis of the format of the graphs, figures, and tables students will determine whether the chosen methods enable straightforward, independent analysis or push the reader to accept the authors conclusions. Students will reformat the presentation of the data to determine whether other representations would reveal / support different conclusions. In a final project, students will use and build up on previous knowledge to analyze data to related to a global, national, or policy decision. [STSC ...
TY - JOUR. T1 - Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA). AU - Groeneveld, E.. AU - Broeze, K. A.. AU - Lambers, M. J.. AU - Haapsamo, M.. AU - Dirckx, K.. AU - Schoot, B. C.. AU - Salle, B.. AU - Duvan, C. I.. AU - Schats, R.. AU - Mol, B. W.. AU - Hompes, P. G.A.. PY - 2011/7/1. Y1 - 2011/7/1. N2 - Background: Aspirin is believed to improve the outcome of IVF, but previous conventional meta-analyses on the subject are conflicting. Therefore, we performed a meta-analysis with individual patient data (IPD MA) of randomized clinical trials (RCTs) on the subject. Methods: A systematic literature search was conducted to identify RCTs assessing the effectiveness of aspirin in IVF. Authors were asked to share their original data. In a one step meta-analytic approach, the treatment effect of aspirin was estimated with odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression, based on the ...
Protocol for a systematic review and individual patient data meta-analysis of benefit of so-called lung-protective ventilation settings in patients under general anesthesia for surgery. . Biblioteca virtual para leer y descargar libros, documentos, trabajos y tesis universitarias en PDF. Material universiario, documentación y tareas realizadas por universitarios en nuestra biblioteca. Para descargar gratis y para leer online.
TY - JOUR. T1 - Monitoring initial response to Angiotensin-converting enzyme inhibitor-based regimens. T2 - An individual patient data meta-analysis from randomized, placebo-controlled trials. AU - Bell, Katy J L. AU - Hayen, Andrew. AU - Macaskill, Petra. AU - Craig, Jonathan C. AU - Neal, Bruce C. AU - Fox, Kim M. AU - Remme, Willem J. AU - Asselbergs, Folkert W. AU - van Gilst, Wiek H. AU - Macmahon, Stephen. AU - Remuzzi, Giuseppe. AU - Ruggenenti, Piero. AU - Teo, Koon K. AU - Irwig, Les. PY - 2010/9. Y1 - 2010/9. N2 - Most clinicians monitor blood pressure to estimate a patients response to blood pressure-lowering therapy. However, the apparent change may not actually reflect the effect of the treatment, because a persons blood pressure varies considerably even without the administration of drug therapy. We estimated random background within-person variation, apparent between-person variation, and true between-person variation in blood pressure response to angiotensin-converting enzyme ...
TY - JOUR. T1 - Quantifying the effects of prior acetyl-salicylic acid on sepsis-related deaths. T2 - An individual patient data meta-analysis using propensity matching. AU - Trauer, James. AU - Muhi, Stephen. AU - McBryde, Emma S.. AU - Al Harbi, Shmeylan A.. AU - Arabi, Yaseen M.. AU - Boyle, Andrew J.. AU - Cartin-Ceba, Rodrigo. AU - Chen, Wei. AU - Chen, Yung Tai. AU - Falcone, Marco. AU - Gajic, Ognjen. AU - Godsell, Jack. AU - Gong, Michelle Ng. AU - Kor, Daryl. AU - Lösche, Wolfgang. AU - McAuley, Daniel F.. AU - ONeal, Hollis R.. AU - Osthoff, Michael. AU - Otto, Gordon P.. AU - Sossdorf, Maik. AU - Tsai, Min Juei. AU - Valerio-Rojas, Juan C.. AU - Van Der Poll, Tom. AU - Violi, Francesco. AU - Ware, Lorraine. AU - Widmer, Andreas F.. AU - Wiewel, Maryse A.. AU - Winning, Johannes. AU - Eisen, Damon P.. N1 - Funding Information: Drs. Gong, Kor, ONeal, and Ware received support for article research from the National Institutes of Health (NIH). Dr. Gongs institution received funding ...
TY - JOUR. T1 - The price is right!? A meta-regression analysis on willingness to pay for local food. AU - Printezis, Iryna. AU - Grebitus, Carola. AU - Hirsch, Stefan. PY - 2019/5/1. Y1 - 2019/5/1. N2 - We study the literature on willingness to pay (WTP) for local food by applying meta-regression analysis to a set of 35 eligible research papers that provide 86 estimates on consumers WTP for the attribute local. An analysis of the distribution of WTP measures suggests the presence of publication selection bias that favors larger and statistically significant results. The analyzed literature provides evidence for statistically significant differences among consumers WTP for various types of product. Moreover, we find that the methodological approach (choice experiments vs. other approaches) and the analyzed country can have a significant influence on the generated WTP for local.. AB - We study the literature on willingness to pay (WTP) for local food by applying meta-regression analysis to a ...
© 2015 World Stroke Organization. Background: Aspirin is of moderate overall benefit for patients with acute disabling ischemic stroke. It is unclear whether functional outcome could be improved after stroke by targeting aspirin to patients with a high risk of recurrent thrombosis or a low risk of haemorrhage. Aims: We aimed to determine whether patients at higher risk of thrombotic events or poor functional outcome, or lower risk of major haemorrhage had a greater absolute risk reduction of poor functional outcome with aspirin than the average patient. Methods: We used data on individual ischemic stroke patients from three large trials of aspirin vs. placebo in acute ischemic stroke: the first International Stroke Trial (n=18372), the Chinese Acute Stroke Trial (n=20172) and the Multicentre Acute Stroke Trial (n=622). We developed and evaluated clinical prediction models for the following: early thrombotic events (myocardial infarction, ischemic stroke, deep vein thrombosis and pulmonary embolism);
Biological Abstracts (BIOSIS Previews), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Current Awareness in Biological Sciences (CABS), Current Contents /Life Sciences and Clinical Medicine, Chemical Abstracts (CA Search and CAS Online), Cambridge Scientific Abstracts (Life Sciences Collection), Sociedad Iberoamericana de Informaci n Cientifica (SIIC) Data Bases, Current Advances in Clinical Chemistry, SCISEARCH, Excerpta Medica (EMBASE), International Pharmaceutical Abstracts (International Pharmaceutical Abstracts), Medical Documentation Service, Iowa Drug Information Service (IDIS), PsycINFO (Psychological Abstracts), Research Alert, Science Citation Index, Derwent ...
Based on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. A meta-analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA in specific subgroups of patients with severe pain and (mild) inflammatory signs, over both short-term and long-term follow-up, using IPD from existing studies; to reach consensus on the rules for cooperation in a consortium; and to develop and explore the methodological issues of meta-analysis with individual OA patient data ...
An Individual Patient Data (IPD) meta-analysis is often considered the gold-standard for synthesising survival data from clinical trials. An IPD meta-analysis can be achieved by either a two-stage or a one-stage approach, depending on whether the trials are analysed separately or simultaneously. A range of one-stage hierarchical Cox models have been previously proposed, but these are known to be computationally intensive and are not currently available in all standard statistical software. We describe an alternative approach using Poisson based Generalised Linear Models (GLMs). We illustrate, through application and simulation, the Poisson approach both classically and in a Bayesian framework, in two-stage and one-stage approaches. We outline the benefits of our one-stage approach through extension to modelling treatment-covariate interactions and non-proportional hazards. Ten trials of hypertension treatment, with all-cause death the outcome of interest, are used to apply and assess the approach. We
An Individual Patient Data (IPD) meta-analysis is often considered the gold-standard for synthesising survival data from clinical trials. An IPD meta-analysis can be achieved by either a two-stage or a one-stage approach, depending on whether the trials are analysed separately or simultaneously. A range of one-stage hierarchical Cox models have been previously proposed, but these are known to be computationally intensive and are not currently available in all standard statistical software. We describe an alternative approach using Poisson based Generalised Linear Models (GLMs). We illustrate, through application and simulation, the Poisson approach both classically and in a Bayesian framework, in two-stage and one-stage approaches. We outline the benefits of our one-stage approach through extension to modelling treatment-covariate interactions and non-proportional hazards. Ten trials of hypertension treatment, with all-cause death the outcome of interest, are used to apply and assess the approach. We
According to previous meta-analyses, coffee consumption reduces the risk of type 2 diabetes mellitus. However, the underlying mechanism remains unknown. Whether caffeine, the key ingredient in coffee, has a beneficial effect on the glycemic homeostasis and the anti-diabetic effect is particularly controversial. The aim of this study was to summarize the effect of acute caffeine ingestion on insulin sensitivity in healthy men. A comprehensive literature search for papers published before April 2016 was conducted in EMBASE, PubMed, and Cochrane Library databases. Randomized controlled trials (RCTs) that investigated the effect of caffeine on insulin sensitivity in healthy humans without diabetes were included. A random effects meta-analysis was conducted using Review Manager 5.3. The search yielded 7 RCTs in which caffeine intake was the single variant. Compared with placebo, caffeine intake significantly decreased the insulin sensitivity index, with a standardized mean difference of −2.06 (95%
Background Non-invasive ventilation (NIV) may be a means to temporarily reverse or slow the progression of respiratory failure in cystic fibrosis (CF). Objectives To compare the effect of NIV versus no NIV in people with CF. Search strategy We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. We searched the reference lists of each trial for additional publications possibly containing other trials. Most recent search: June 2008. Selection criteria Randomised controlled trials comparing a form of pressure preset or volume preset NIV to no NIV in people with acute or chronic respiratory failure in CF. Data collection and analysis Three reviewers independently assessed trials for inclusion criteria and methodological quality, and extracted data. Main results Fifteen trials were identified; seven trials met the ...
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Ancient Egyptian medical papyri (1550 BC) already emphasised diagnosis by physical examination as the cornerstone of the decision to treat or not to treat an ailment [1]. Today, the clinical assessment of the probability of a disease comes from a series of implicitly and explicitly performed tests. In addition to the implicit diagnostic information from history (risk factors and symptoms) and clinical examination (signs), many additional diagnostic imaging or laboratory tests are available. The accuracy of such tests requires to be appropriately assessed before they can be used in clinical practice.. Studies on primary diagnostic research typically examine the accuracy of a test isolated from history and clinical examination or do not adjust for overlap of information captured by clinical history, physical examination and additional tests. Such studies and conventional meta-analyses of their reported results will therefore not show how useful the test will be in practice [2-4].. In addition to ...
BACKGROUND: There are well over a million homeless people in Western Europe and North America, but reliable estimates of the prevalence of major mental disorders among this population are lacking. We undertook a systematic review of surveys of such disorders in homeless people. METHODS AND FINDINGS: We searched for surveys of the prevalence of psychotic illness, major depression, alcohol and drug dependence, and personality disorder that were based on interviews of samples of unselected homeless people. We searched bibliographic indexes, scanned reference lists, and corresponded with authors. We explored potential sources of any observed heterogeneity in the estimates by meta-regression analysis, including geographical region, sample size, and diagnostic method. Twenty-nine eligible surveys provided estimates obtained from 5,684 homeless individuals from seven countries. Substantial heterogeneity was observed in prevalence estimates for mental disorders among the studies (all Cochrans chi(2)
Harriet L., MacMillan, Professor, Gene Feder, Professor McMaster University and University of Bristol May 18, 2012 Link between evidence and conclusion unclear in USPSTF IPV screening systematic review As two clinician-researchers involved in the intimate partner violence (IPV) screening trial (1) that featured prominently in the recent US Preventive Services Task Force (USPSTF) systematic review on screening women for IPV (2), we were perplexed by the authors conclusion that IPV screening can provide benefits that vary by population. This was the only trial identified as meeting the inclusion criteria to address question 1 of the review: Does screening asymptomatic women in health care settings for current, past, or increased risk for IPV reduce exposure to IPV, physical or mental harms, or mortality? Given that the trial results showed no differences between groups and the overall quality of the study was considered fair, presumably the answer to question 1 would be no - which is what ...
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TY - JOUR. T1 - Repeat prenatal corticosteroid prior to preterm birth. T2 - A systematic review and individual participant data meta-analysis for the PRECISE study group (prenatal repeat corticosteroid international IPD study group: Assessing the effects using the best level of evidence) - study protocol. AU - Crowther, Caroline A.. AU - Aghajafari, Fariba. AU - Askie, Lisa M.. AU - Asztalos, Elizabeth V.. AU - Brocklehurst, Peter. AU - Bubner, Tanya K.. AU - Doyle, Lex W.. AU - Dutta, Sourabh. AU - Garite, Thomas J.. AU - Guinn, Debra A.. AU - Hallman, Mikko. AU - Hannah, Mary E.. AU - Hardy, Pollyanna. AU - Maurel, Kimberly. AU - Mazumder, Premasish. AU - McEvoy, Cynthia (Cindy). AU - Middleton, Philippa F.. AU - Murphy, Kellie E.. AU - Peltoniemi, Outi M.. AU - Peters, Dawn. AU - Sullivan, Lisa. AU - Thom, Elizabeth A.. AU - Voysey, Merryn. AU - Wapner, Ronald J.. AU - Yelland, Lisa. AU - Zhang, Sasha. PY - 2012/2/12. Y1 - 2012/2/12. N2 - Background: The aim of this individual participant ...
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Intermittent claudication is pain in the legs due to muscle ischaemia associated with arterial stenosis or occlusion. Angioplasty is a technique that involves dilatation and recanalisation of a stenosed or occluded artery. The objective of this review was to determine the effects of angioplasty of arteries in the leg when compared with non surgical therapy, or no therapy, for people with mild to moderate intermittent claudication. Sources searched include the Cochrane Peripheral Vascular Diseases Groups Specialized Trials Register (August 2006), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 3, 2006) and reference lists of relevant articles. The review authors also contacted investigators in the field and handsearched relevant conference proceedings (August 2006). Randomised trials of angioplasty for mild or moderate intermittent claudication. The contact author selected suitable trials and this was checked by the other review author. Both review authors assessed trial ...
OBJECTIVE: To systematically review the efficacy and tolerability of fluoxetine, the most widely studied of newer antidepressants, in comparison with all other antidepressants in the acute treatment of depression in patients aged more than 18 years. DATA SOURCES: Studies were identified through electronic searches of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register and the Cochrane Central Register of Controlled Trials up to March 2004. The terms FLUOXETIN* OR adofen or docutrix or erocap or fluctin or fluctine or fluoxeren or fontex or ladose or lorien or lovan or mutan or prozac or prozyn or reneuron or sanzur or saurat or zactin were used. MEDLINE (1966-2004) and EMBASE (1974-2004) were searched using fluoxetine and randomized controlled trial or random allocation or double-blind method. No language restrictions were applied. Reference lists of relevant papers and previous systematic reviews were hand-searched for published reports up to March 2004. STUDY
BACKGROUND: Much of the brain swelling in ischaemic stroke is due to cytotoxic oedema, which is related to cell membrane dysfunction. Early treatment with corticosteroids may help reduce the swelling and improve the outcomes after a stroke. OBJECTIVES: The objective of this review was to assess the effect of corticosteroids in acute presumed ischaemic stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group trials register and contacted investigators in the field. SELECTION CRITERIA: Published randomised trials comparing corticosteroids with placebo or control in people with acute (presumed or definite) ischaemic stroke. Trials were included if treatment began within 48 hours of stroke onset and if clinical outcome was assessed. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied the inclusion criteria, assessed trial quality and extracted the data. MAIN RESULTS: Seven trials involving 453 people were included. Details of trial quality that may relate to bias were not available from
Complementary and alternative medicine (CAM) is increasingly used for treatment of inflammatory bowel disease (IBD). Acupuncture-type treatments are among the most popular options. Several studies have reported that moxibustion is effective in ulcerative colitis (UC). The objective of this review was to assess the clinical evidence for or against moxibustion as a treatment for UC. We searched the literature using 18 databases from their inception to February 10, 2010, without language restrictions. We included randomized clinical trials (RCTs), in which human patients with UC were treated with moxibustion. Studies were included if they were placebo-controlled or controlled against a drug therapy or no treatment group. The methodological quality of all RCTs was assessed using the Cochrane risk of bias. In total, five RCTs were included. All were of low methodological quality. They compared the effects of moxibustion with conventional drug therapy. Three tested moxibustion against sulfasalazine and two
TY - JOUR. T1 - Adaptive randomization of neratinib in early breast cancer. AU - the I-SPY 2 Investigators. AU - Park, John W.. AU - Liu, Minetta C.. AU - Yee, Douglas. AU - Yau, Christina. AU - Vant Veer, Laura J.. AU - Symmans, W. Fraser. AU - Paoloni, Melissa. AU - Perlmutter, Jane. AU - Hylton, Nola M.. AU - Hogarth, Michael. AU - DeMichele, Angela. AU - Buxton, Meredith B.. AU - Chien, A. Jo. AU - Wallace, Anne M.. AU - Boughey, Judy C.. AU - Haddad, Tufia C.. AU - Chui, Stephen Y.. AU - Kemmer, Kathleen A.. AU - Kaplan, Henry G.. AU - Isaacs, Claudine. AU - Nanda, Rita. AU - Tripathy, Debasish. AU - Albain, Kathy S.. AU - Edmiston, Kirsten K.. AU - Elias, Anthony D.. AU - Northfelt, Donald W.. AU - Pusztai, Lajos. AU - Moulder, Stacy L.. AU - Lang, Julie E.. AU - Viscusi, Rebecca K.. AU - Euhus, David M.. AU - Haley, Barbara B.. AU - Khan, Qamar J.. AU - Wood, William C.. AU - Melisko, Michelle. AU - Schwab, Richard. AU - Helsten, Teresa. AU - Lyandres, Julia. AU - Davis, Sarah E.. AU - ...
Review authors will work independently to assess risk of bias using criteria described in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2011) to assess trial quality. This set of criteria is based on evidence of associations between overestimate of effect and high risk of bias of the article such as sequence generation, allocation concealment, blinding, incomplete outcome data and selective reporting. If the raters disagreed, the final rating was made by consensus, with the involvement of another member of the review group. Where inadequate details of randomization and other characteristics of trials were provided, authors of the studies were contacted in order to obtain further information. Nonconcurrence in quality assessment was reported, but if disputes arose as to in which category a trial was to be allocated, again, resolution was made by discussion. The level of risk of bias was noted in both the text of the review and in the Summary of findings tables. ...
Recently, network meta-analysis of survival data with a multidimensional treatment effect was introduced. With these models the hazard ratio is not assumed to be constant over time, thereby reducing the possibility of violating transitivity in indirect comparisons. However, bias is still present if there are systematic differences in treatment effect modifiers across comparisons. In this paper we present multidimensional network meta-analysis models for time-to-event data that are extended with covariates to explain heterogeneity and adjust for confounding bias in the synthesis of evidence networks of randomized controlled trials. The impact of a covariate on the treatment effect can be assumed to be treatment specific or constant for all treatments compared. An illustrative example analysis is presented for a network of randomized controlled trials evaluating different interventions for advanced melanoma. Incorporating a covariate related to the study date resulted in different estimates for the hazard
The authors included non-English trials in the review. The inclusion criteria for the individual trials and their participants were stated, and the author assessed the quality of the primary trials. It was not stated, however, how the trials were selected for inclusion or how study quality was assessed.. The authors listed the primary trials and the data extracted in tabular format, and discussed these data in the review. However, some of the participants details, i.e. age and gender, were not reported consistently.. The authors presented the data in a narrative format but did not report any statistical measurements that were used in the individual trials. This made it impossible to verify the results stated by the authors in this review. Heterogeneity was assessed in the narrative, based on the study characteristics used in the trials.. It was not possible to evaluate whether the authors conclusions were supported by their review due to the lack of primary data reported.. ...
Fingerprint Dive into the research topics of Prognostic factors for adolescent knee pain: an individual participant data meta-analysis of 1281 patients. Together they form a unique fingerprint. ...
Systemic therapy for treating locoregional recurrence in women with breast cancer: Cochrane systematic review answers are found in the Cochrane Abstracts powered by Unbound Medicine. Available for iPhone, iPad, Android, and Web.
Interventions to improve adherence to lipid-lowering medication: Cochrane systematic review answers are found in the Cochrane Abstracts powered by Unbound Medicine. Available for iPhone, iPad, Android, and Web.
BRILINTA reduced cardiovascular events in these patients with no prior heart attack or stroke. The Phase III THEMIS trial met its primary endpoint which demonstrated that BRILINTA® (ticagrelor) tablets, taken in conjunction with aspirin, showed a statistically-significant reduction in major adverse cardiovascular events (MACE, a composite of cardiovascular death, heart attack and stroke) compared to aspirin alone.. THEMIS was conducted in over 19,000 patients with coronary artery disease (CAD) and type-2 diabetes (T2D) with no prior heart attack or stroke. Preliminary safety results were consistent with the known profile of BRILINTA. A full evaluation of the THEMIS data will be presented at a forthcoming medical meeting.. Elisabeth Björk, Senior Vice President, Head of late Cardiovascular, Renal and Metabolism, R&D BioPharmaceuticals, said: Approaches to help reduce cardiovascular morbidity further in patients with coronary artery disease and type-2 diabetes are urgently needed. The positive ...
PURPOSE: To compare the effectiveness and adverse event profiles of amylin agonists, DPP-4 inhibitors, incretin mimetics, TZDs, and certain combination products for people with type 2 diabetes and for people with type 1 diabetes for pramlintide only. DATA SOURCES: To identify published studies, we searched MEDLINE, The Cochrane Library, Embase, International Pharmaceutical Abstracts, and reference lists of included studies through July 2010. We also requested dossiers of information from pharmaceutical manufacturers. REVIEW METHODS: Study selection, data abstraction, validity assessment, grading the strength of the evidence (SOE), and data synthesis were all carried out according to standard Drug Effectiveness Review Project methods. RESULTS: Most of the evidence was limited to adult populations. Most of the included studies evaluated intermediate outcomes, such as HbA1c or weight. Very few studies reported health outcomes and few studies were longer than 6 months. For the amylin agonists, ...
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Scott W, Guildford BJ, Badenoch J, Driscoll E, Chilcot J, Norton S, Kemp HI, Lee MJ, Lwanga J, Boffito M, Moyle G, Post FA, Campbell L, Josh J, Cift P, de C Williams AC, Rice ASC, McCracken ...