Browsing by Subject "Meta-analysis"
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Item Open Access Combination radiofrequency ablation and vertebral cement augmentation for spinal metastatic tumors: A systematic review and meta-analysis of safety and treatment outcomes.(North American Spine Society journal, 2024-03) Chen, Andrew L; Sagoo, Navraj S; Vannabouathong, Christopher; Reddy, Yashas; Deme, Sathvik; Patibandla, Sahiti; Passias, Peter G; Vira, ShaleenBackground
The treatment of spine metastases continues to pose a significant clinical challenge, requiring the integration of multiple therapeutic modalities to address the multifactorial aspects of this disease process. Radiofrequency ablation (RFA) and vertebral cement augmentation (VCA) are 2 less invasive modalities compared to open surgery that have emerged as promising strategies, offering the potential for both pain relief and preservation of vertebral stability. The utility of these approaches, however, remains uncertain and subject to ongoing investigation.This systematic review and meta-analysis evaluates the available evidence and synthesize the results of studies that have investigated the combination of RFA and VCA for the treatment of spinal metastases, with the goal of providing a comprehensive and up-to-date assessment of the efficacy and safety of this therapeutic approach.Methods
A literature search was conducted using the electronic databases PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus from their inception to May 4th, 2022 in accordance with PRISMA guidelines. Studies were included if they met the following criteria: 1) spine metastases treated with RFA in combination with VCA, 2) available data on at least one outcome (i.e., pain palliation, complications, local tumor control), 3) prospective or retrospective studies with at least 10 patients, and 4) English language. Meta-analyses were conducted in R (R Foundation for Statistical Computing; Vienna, Austria), using the meta package.Results
In the 25 included studies, a total of 947 patients (females=53.9%) underwent RFA + VCA for spinal metastatic tumors. Out of 1,163 metastatic lesions, the majority were located in the lumbar region (585/1,163 [50.3%]) followed by thoracic (519/1,163 [44.6%]), sacrum (39/1,163 [3.4%]), and cervical (2/1,163 [0.2%]). 48/72 [66.7%] metastatic lesions expanded into the posterior elements. Preoperative pathologic vertebral fractures were identified in 115/176 [65.3%] patients. Between pre-procedure pain scores and postprocedure pain scores, average follow-up (FU) was 4.41±2.87 months. Pain scores improved significantly at a short-term FU (1-6 months), with a pooled mean difference (MD) from baseline of 4.82 (95% CI, 4.48-5.16). The overall local tumor progression (LTP) rate at short-term FU (1-6 months) was 5% (95% CI, 1%-8%), at mid-term FU (6-12 months) was 22% (95% CI, 0%-48%), and at long-term FU (>12 months) was 5% (95% CI, 0%-11%). The pooled incidence of total complications was 1% (95% CI, 0%-1%), the most frequent of which were transient radicular pain and asymptomatic cement extravasation.Conclusions
The findings of this meta-analysis reveal that the implementation of RFA in conjunction with VCA for the treatment of spinal metastatic tumors resulted in a significant short-term reduction of pain, with minimal total complications. The LTP rate was additionally low. The clinical efficacy and safety of this technique are established, although further exploration of the long-term outcomes of RFA+VCA is warranted.Item Open Access Effects of online repetitive transcranial magnetic stimulation (rTMS) on cognitive processing: A meta-analysis and recommendations for future studies.(Neuroscience and biobehavioral reviews, 2019-12) Beynel, Lysianne; Appelbaum, Lawrence G; Luber, Bruce; Crowell, Courtney A; Hilbig, Susan A; Lim, Wesley; Nguyen, Duy; Chrapliwy, Nicolas A; Davis, Simon W; Cabeza, Roberto; Lisanby, Sarah H; Deng, Zhi-DeOnline repetitive transcranial magnetic stimulation (rTMS), applied while subjects are performing a task, is widely used to disrupt brain regions underlying cognition. However, online rTMS has also induced "paradoxical enhancement". Given the rapid proliferation of this approach, it is crucial to develop a better understanding of how online stimulation influences cognition, and the optimal parameters to achieve desired effects. To accomplish this goal, a quantitative meta-analysis was performed with random-effects models fitted to reaction time (RT) and accuracy data. The final dataset included 126 studies published between 1998 and 2016, with 244 total effects for reaction times, and 202 for accuracy. Meta-analytically, rTMS at 10 Hz and 20 Hz disrupted accuracy for attention, executive, language, memory, motor, and perception domains, while no effects were found with 1 Hz or 5 Hz. Stimulation applied at and 10 and 20 Hz slowed down RTs in attention and perception tasks. No performance enhancement was found. Meta-regression analysis showed that fMRI-guided targeting and short inter-trial intervals are associated with increased disruptive effects with rTMS.Item Open Access Meta-Analysis of Stated Preference Environmental Valuation Studies in China, with Implications for Benefit Transfer(2014-04-25) Wang, ZhanAs an approach for nonmarket valuation, benefit transfer uses the results of existing studies to predict the values of goods and services at sites where original valuation studies have not been conducted. It has the advantage of saving time and funding, but it depends heavily on the characteristics of the original studies as well as the transfer method. Considering the increasing demand for environmental valuation in China, benefit transfer may play an important role in assisting natural resource and environment management. This Master’s project created a database of stated preference studies on environmental valuation in China (Mainland China, Hong Kong, Macau and Taiwan), and it applied a meta-analytic benefit transfer approach to the database to study factors that influence willingness to pay and the accuracy of alternative benefit transfer methods. The results indicated that the number of stated preference valuation studies in China has increased in recent decades, but the studies are distributed unevenly across the country and focus on different environmental assets in different regions and time periods. The meta-analysis found that several variables, including response format, research format, payment interval, payment vehicle, document type, and specific environmental assets such as air quality, have a significant influence on willingness to pay estimates. A trimmed version of the full model had the best performance in terms of transfer accuracy, followed by a stepwise trimmed model, a central tendency approach, and the full model. These findings suggest that the meta-analytic benefit transfer method can serve as a useful tool for Chinese environmental management.Item Open Access Model validity and risk of bias in randomised placebo-controlled trials of individualised homeopathic treatment.(Complement Ther Med, 2016-04) Mathie, Robert T; Van Wassenhoven, Michel; Jacobs, Jennifer; Oberbaum, Menachem; Frye, Joyce; Manchanda, Raj K; Roniger, Helmut; Dantas, Flávio; Legg, Lynn A; Clausen, Jürgen; Moss, Sian; Davidson, Jonathan RT; Lloyd, Suzanne M; Ford, Ian; Fisher, PeterBACKGROUND: To date, our programme of systematic reviews has assessed randomised controlled trials (RCTs) of individualised homeopathy separately for risk of bias (RoB) and for model validity of homeopathic treatment (MVHT). OBJECTIVES: The purpose of the present paper was to bring together our published RoB and MVHT findings and, using an approach based on GRADE methods, to merge the quality appraisals of these same RCTs, examining the impact on meta-analysis results. DESIGN: Systematic review with meta-analysis. METHODS: As previously, 31 papers (reporting a total of 32 RCTs) were eligible for systematic review and were the subject of study. MAIN OUTCOME MEASURES: For each trial, the separate ratings for RoB and MVHT were merged to obtain a single overall quality designation ('high', 'moderate, "low", 'very low'), based on the GRADE principle of 'downgrading'. RESULTS: Merging the assessment of MVHT and RoB identified three trials of 'high quality', eight of 'moderate quality', 18 of 'low quality' and three of 'very low quality'. There was no association between a trial's MVHT and its RoB or its direction of treatment effect (P>0.05). The three 'high quality' trials were those already labelled 'reliable evidence' based on RoB, and so no change was found in meta-analysis based on best-quality evidence: a small, statistically significant, effect favouring homeopathy. CONCLUSION: Accommodating MVHT in overall quality designation of RCTs has not modified our pre-existing conclusion that the medicines prescribed in individualised homeopathy may have small, specific, treatment effects.Item Open Access Risk of coronary artery disease in patients with ankylosing spondylitis: a systematic review and meta-analysis.(Annals of translational medicine, 2015-03) Ungprasert, Patompong; Srivali, Narat; Kittanamongkolchai, WonngarmObjective
To investigate the association between coronary artery disease (CAD) and ankylosing spondylitis (AS).Methods
We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, standardized prevalence ratio or standardized incidence ratios with 95% confidence comparing CAD risk in patients with AS versus non-AS controls. Pooled risk ratios and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance of DerSimonian and Laird.Results
Out of 229 potentially relevant articles, ten studies (five retrospective cohort studies and five cross-sectional studies) were identified and included in our data analysis. The overall pooled risk ratio of CAD in patients with AS was 1.41 (95% CI: 1.29-1.54). The pooled risk ratios for cross-sectional and cohort studies were 2.08 (95% CI: 1.28-3.40) and 1.36 (95% CI: 1.31-1.41), respectively. The statistical heterogeneity of this meta-analysis was moderate with an I(2) of 56%.Conclusions
Our study demonstrated a statistically significant increased CAD risk among patients with AS with 41% excess risk.Item Open Access The Relation Between Self-Regulation and Academic Achievement: A Meta-Analysis Exploring Variation in the Way Constructs are Labeled, Defined, and Measured(2013) Dent, Amy L.Guided by an integrative conceptual framework, a meta-analysis was conducted to explore the relation between the capacity aspect of self-regulation and academic achievement across childhood and adolescence. This meta-analysis of over 150 studies draws upon diverse research traditions and approaches to test moderators of theoretical, methodological, and practical importance. In the theoretical moderator analyses, results were broken down by the specific self-regulation construct (e.g., emotion regulation, executive functions), students' grade level, and academic subject. Doing so permitted an exploration of developmental and domain differences in the relation between each self-regulation construct and achievement. In the methodological moderator analyses, results were broken down by the type of self-regulation measure (e.g., teacher-report, direct assessment) and the type of achievement measure (e.g., standardized test, course grade). Doing so permitted a formal test of how these measures relate to each other, which has garnered considerable debate among self-regulation researchers.
Findings from the five moderator analyses largely supported hypotheses. The average correlation with achievement was strongest for effortful control and composite measures of executive functions, with updating significantly exceeding both shifting and inhibiting. A strong correlation also emerged for self-control, though it differed significantly based on whether the construct was categorized by author labels or definitions. Composite measures of self-regulation revealed a stronger correlation with achievement than any of its domains, as expected. Across all self-regulatory capacities, correlations became significantly stronger after the transition to kindergarten but assumed different trajectories based on the specific construct during the rest of elementary and secondary school. Domain differences also emerged, favoring math and science for executive functions but not producing significant differences with language arts for effortful control. As expected, self-regulatory capacities with an indirect effect on achievement (e.g., effortful control, emotion regulation) had the strongest correlation with course grades while self-regulatory capacities with a direct effect on achievement (e.g., executive functions) had the strongest correlation with standardized tests. Finally, direct assessments and teacher reports produced significantly stronger correlations with academic performance than when students reported their own self-regulation. Theoretical, methodological, and practical implications of these findings are discussed alongside results.
A new meta-analytic method was also developed to identify and resolve inconsistencies in the way psychological constructs are labeled, defined, and measured. This new method provided needed conceptual clarity in the diverse and interdisciplinary literature on self-regulation. Implications for other literatures characterized by variation in the way constructs are labeled, defined, and measured are discussed.
Item Open Access Wildlife in the Southern Blue Ridge Ecoregion: Assessing Management Impacts and Establishing Regional Monitoring Efforts(2016-04-28) Wojcik, Meredith; Mason, Sara; Sowers, Mark; Le, MarkusThe Southern Blue Ridge Mountains are biologically important, harboring many rare and endangered species and high levels of biodiversity. A history of fire suppression in the region has led to loss of biodiversity through the decline of fire-reliant ecosystems. Forest managers have accelerated the reintroduction of fire into the Southern Blue Ridge, but could benefit from more evidence-based information about the effects that fires, and other related management activities, could have on the region’s wildlife. By performing a systematic review and meta-analysis of relevant literature we summarize the impacts that various management activities have on the abundance and diversity of wildlife taxa in this region. Using our analysis we also provide suggestions for collaborative regional wildlife monitoring, highlighting species and taxa that are most sensitive to management.Item Open Access Willingness-to-Pay for Water Quality Improvements in the Androscoggin River: Enhancing Geospatial Validity in Benefit Transfers(2015-04-24) Glidden-Lyon, EmmaGeospatial variables have been omitted from most meta-regression models evaluating water quality improvements, undermining the validity of these studies’ estimations of willingness-to-pay (WTP). This paper takes a recent analysis demonstrating the importance of geospatial variables and applies it to water quality improvements in the Androscoggin River. The Androscoggin River has seen dramatic improvements in water quality since the 1970s but still struggles in certain reaches to meet the minimum state attainment standards. This paper estimates WTP for the historic improvements as well as WTP for additional future changes by applying a new meta-regression model created by Johnston et al. (in review). Johnston et al.'s paper increases the validity of WTP estimations by including three significant geospatial variables: scale of the affected resource; size of the market area; and availability of substitutes (in review). The empirical analysis here also finds that exclusion of the geospatial variables has a large impact on the WTP estimates, with overestimates when the geospatial scale of the market area to the region or affected water body to market area is relatively small and underestimates when these ratios of these variables are relatively large. The results also indicate that there is positive WTP per household for the historic water quality improvements in the Androscoggin River and for possible future water improvements.