Treatment of hypertension reduces cognitive decline in older adults: a systematic review and meta-analysis

ObjectivesTo systematically analyse the effect of pharmacological treatment of hypertension (HTN) on cognitive decline in older adults.MethodsRandomised, placebo-controlled trials with a prespecified quantitative outcome of cognition and a pharmacological intervention for at least 12 months to treat HTN in older adults (>60 years). Our primary outcome was change in cognition with pharmacological treatment of HTN. Standardised mean difference (SMD) was used to analyse different outcomes reported in the selected studies. We searched PubMed CENTRAL and the Cochrane Library from inception to 6 July 2020. Two independent reviewers assessed trial quality and extracted data. Internal and external validity of the studies was assessed.ResultsNine randomised controlled trials with 34 994 participants were included in the final analysis. The net SMD for change in cognition was −0.049 (CI: −0.078 to −0.019) indicating that treatment of HTN decreased cognitive decline. Heterogeneity was low with an I² of 6%.DiscussionCurrent evidence does not indicate worsening of cognition with treatment of HTN. Treatment of HTN in older adults may reduce cognitive decline. These results have important implications in clinical management of patients at risk for dementia.PROSPERO registration numberCRD42020139750.

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Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials

Hernia ◽

10.1007/s10029-019-02049-w ◽

2019 ◽

Vol 23 (6) ◽

pp. 1093-1103 ◽

Cited By ~ 7

Author(s):

P. Gavriilidis ◽

R. J. Davies ◽

J. Wheeler ◽

N. de’Angelis ◽

S. Di Saverio

Keyword(s):

Randomised Controlled Trials ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Vascular Injuries ◽

Lichtenstein Hernioplasty ◽

Randomised Controlled ◽

Haematoma Formation ◽

Over Time

Abstract Background–purpose Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. Methods Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. Results The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = − 6.32 (− 8.17, − 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. Conclusions This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic.

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Strength Training to Prevent Falls in Older Adults: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10143184 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3184

Author(s):

João Gustavo Claudino ◽

José Afonso ◽

Javad Sarvestan ◽

Marcel Bahia Lanza ◽

Juliana Pennone ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Strength Training ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Exercise Interventions ◽

Randomized Controlled ◽

Falls In Older Adults

We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) to assess the effects of strength training (ST), as compared to alternative multimodal or unimodal exercise programs, on the number of falls in older adults (≥60 years). Ten databases were consulted (CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus and Web of Science), without limitations on language or publication date. Eligibility criteria were as follows: RCTs with humans ≥60 years of age of any gender with one group performing supervised ST and a group performing another type of exercise training, reporting data pertaining falls. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis used a random effects model to calculate the risk ratio (RR) for number of falls. Five RCTs with six trials were included (n = 543, 76% women). There was no difference between ST and alternative exercise interventions for falls (RR = 1.00, 95% CI 0.77–1.30, p = 0.99). The certainty of evidence was very low. No dose–response relationship could be established. In sum, ST showed comparable RR based on number of falls in older adults when compared to other multimodal or unimodal exercise modalities, but evidence is scarce and heterogeneous, and additional research is required for more robust conclusions. Registration: PROSPERO CRD42020222908.

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Robotic Versus Laparoscopic Rectal Surgery for Rectal Cancer: A Meta-Analysis of 7 Randomized Controlled Trials

Surgical Innovation ◽

10.1177/1553350619839853 ◽

2019 ◽

Vol 26 (4) ◽

pp. 497-504 ◽

Cited By ~ 6

Author(s):

Laiyuan Li ◽

Weisheng Zhang ◽

Yinyin Guo ◽

Xiaolin Wang ◽

Huichuan Yu ◽

...

Keyword(s):

Confidence Interval ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Rectal Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Complication Rates ◽

Randomized Controlled ◽

Laparoscopic Rectal Surgery

Background. Robotic surgery has been recently used as a novel tool for rectal surgery. This study assessed the current evidence regarding the efficiency, safety, and potential advantages of robotic rectal surgery (RRS) compared with laparoscopic rectal surgery (LRS). Methods. We comprehensively searched PubMed, Embase, and the Cochrane Library databases and performed a systematic review and cumulative meta-analysis of all randomized controlled trials (RCTs) assessing the 2 approaches. Results. Seven RCTs including a total of 1022 cases were identified. The conversion rate is significantly lower for RRS (odds ratio: 0.29; 95% confidence interval: 0.09 to 0.96; P = .04). The length of the distal margin was significantly shorter in the LRS group than in the RRS group (weighted mean difference: 0.60; 95% confidence interval: 0.09 to 1.10; P = .02). Perioperative complication rates, harvested lymph nodes, positive circumferential resection margins, complete total mesorectal excision, first flatus, and length of stay did not differ significantly between approaches ( P > .05). Conclusions. This meta-analysis indicates that RRS is a safe and effective approach. It is not inferior to LRS in terms of oncologic outcomes and postoperative complications. Future large-volume, well-designed RCTs with extensive follow-up are awaited to confirm and update the findings of this analysis.

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Comparison of pathologic outcomes of robotic and open resections for rectal cancer: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0245154 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245154

Author(s):

Yinyin Guo ◽

Yichen Guo ◽

Yanxin Luo ◽

Xia Song ◽

Hui Zhao ◽

...

Keyword(s):

Rectal Cancer ◽

Lymph Nodes ◽

Meta Analysis ◽

Rectal Surgery ◽

Current Evidence ◽

Cochrane Library ◽

Resection Margins ◽

Controlled Trials ◽

Robotic Resection ◽

The Cochrane Library

Objective The application of robotic surgery for rectal cancer is increasing steadily. The purpose of this meta-analysis is to compare pathologic outcomes among patients with rectal cancer who underwent open rectal surgery (ORS) versus robotic rectal surgery (RRS). Methods We systematically searched the literature of EMBASE, PubMed, the Cochrane Library of randomized controlled trials (RCTs) and nonrandomized controlled trials (nRCTs) comparing ORS with RRS. Results Fourteen nRCTs, including 2711 patients met the predetermined inclusion criteria and were included in the meta-analysis. Circumferential resection margin (CRM) positivity (OR: 0.58, 95% CI, 0.29 to 1.16, P = 0.13), number of harvested lymph nodes (WMD: −0.31, 95% CI, −2.16 to 1.53, P = 0.74), complete total mesorectal excision (TME) rates (OR: 0.93, 95% CI, 0.48 to 1.78, P = 0.83) and the length of distal resection margins (DRM) (WMD: −0.01, 95% CI, −0.26 to 0.25, P = 0.96) did not differ significantly between the RRS and ORS groups. Conclusion Based on the current evidence, robotic resection for rectal cancer provided equivalent pathological outcomes to ORS in terms of CRM positivity, number of harvested lymph nodes and complete TME rates and DRM.

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The Effectiveness of Technology-Based Interventions for Reducing Loneliness in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Psychology ◽

10.3389/fpsyg.2021.711030 ◽

2021 ◽

Vol 12 ◽

Author(s):

Wenjing Jin ◽

Yihong Liu ◽

Shulin Yuan ◽

Ruhai Bai ◽

Xuebin Li ◽

...

Keyword(s):

Older Adults ◽

Rating Scale ◽

Assessment Tool ◽

Controlled Trial ◽

Meta Analysis ◽

Risk Of Bias ◽

Current Evidence ◽

Cochrane Library ◽

Control Groups ◽

Randomized Controlled

Objective: To systematically analyze the effectiveness of technology-based interventions for reducing loneliness in older adults.Methods: We searched relevant electronic databases from inception to April 2021, which included Cochrane Library, PubMed, Web of Science, SpringerLink, EMBASE, CNKI, and Wanfang. The following criteria were used: (i) study design—randomized controlled trial (RCT) designs, (ii) people—older adults (aged ≥ 60 years), (iii) intervention—technology-based interventions in which a core component involved the use of technology to reduce loneliness in older adults; and (iv) outcome—reduction of loneliness level in terms of rating scale scores. Two reviewers independently identified eligible studies, extracted data, and assessed the risk of bias in the included studies. A third reviewer resolved any conflicts. The Cochrane Collaboration's bias assessment tool was used to evaluate the risk of bias for the included studies, and Review Manager 5.4 software was used for the meta-analysis. A random effects model was adopted to measure estimates of loneliness reduction, and standard mean differences (SMD) with a 95% confidence interval (CI) were calculated for each intervention-control contrast, and the I2 statistic was applied to examine heterogeneity.Results: A total of 391 participants from six RCTs were included in the review. Of these, three studies were rated as low-quality, and the remaining three were rated as moderate-quality studies. The meta-analysis showed that the evidence regarding the effects on loneliness of technology-based interventions compared with control groups was uncertain, and suggested that technology-based interventions resulted in little to no difference in loneliness reduction compared to control groups (SMD = −0.08, 95% CI −0.33 to 0.17, p = 0.53). Two types of technology-based interventions were identified: smartphone-based video calls and computer-based training with Internet usage. The subgroup analysis found low-quality evidence to support the effectiveness of both intervention types (SMD = −0.01, 95% CI −0.25 to 0.24, p = 0.95, and SMD = −0.38, 95% CI −0.19, 0.64, p = 0.47, respectively).Conclusions: We found no current evidence to support that technology-based interventions were effective compared to different control conditions in reducing loneliness in older adults. This suggests that more research is needed to investigate the effects of technology-based interventions on loneliness in older adults.

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Electro-Acupuncture is Beneficial for Knee Osteoarthritis: The Evidence from Meta-Analysis of Randomized Controlled Trials

The American Journal of Chinese Medicine ◽

10.1142/s0192415x17500513 ◽

2017 ◽

Vol 45 (05) ◽

pp. 965-985 ◽

Cited By ~ 43

Author(s):

Na Chen ◽

Jing Wang ◽

Attilio Mucelli ◽

Xu Zhang ◽

Changqing Wang

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Physical Function ◽

Pharmacological Treatment ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Great Opportunity ◽

Randomized Controlled

Knee osteoarthritis (KOA) is a common chronic degenerative disease of the elderly. Electro-acupuncture (EA) is considered as a beneficial treatment for KOA, but the conclusion is controversial. This systematic review compiled the evidence from 11 randomized controlled trials to objectively assess the effectiveness and safety of EA for KOA. Eight databases including PubMed, Cochrane Library, Clinic trials, Foreign Medical Literature Retrial Service (FMRS), Science Direct, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), and Wanfang Data were extensively searched up to 5 July 2016. The outcomes included the evaluation of effectiveness, pain and physical function. Risk of bias was evaluated according to the Cochrane risk of bias tool. Eleven RCTs with 695 participants were included. Meta-analysis indicated that EA was more effective than pharmacological treatment (RR [Formula: see text] 1.14; 95% CI [Formula: see text] 1.01,1.28; [Formula: see text]) and manual acupuncture (RR [Formula: see text] 1.12; 95% CI [Formula: see text] 1.02,1.22; [Formula: see text]). Also, EA had a more significant effect in reducing the pain intensity (SMD [Formula: see text]; 95% CI [Formula: see text]; [Formula: see text]) and improving the physical function in the perspective of WOMAC (MD [Formula: see text]; 95% CI [Formula: see text], 5.56; [Formula: see text]) and LKSS (pharmacological treatment: MD [Formula: see text]; 95% CI [Formula: see text], 6.64; [Formula: see text]). Furthermore, these studies implied that EA should be performed for at least 4 weeks. Conclusively, the results indicate that EA is a great opportunity to remarkably alleviate the pain and improve the physical function of KOA patients with a low risk of adverse reaction. Therefore, more high quality RCTs with rigorous methods of design, measurement and evaluation are needed to confirm the long-term effects of EA for KOA.

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Benefits of Adjuvant Mitotane after Resection of Adrenocortical Carcinoma: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2018/9362108 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Yongquan Tang ◽

Zhihong Liu ◽

Zijun Zou ◽

Jiayu Liang ◽

Yiping Lu ◽

...

Keyword(s):

Distant Metastasis ◽

Adrenocortical Carcinoma ◽

Retrospective Studies ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Recurrence Free Survival ◽

Free Survival ◽

Review Current

Background. The adjuvant use of mitotane on adrenocortical carcinoma (ACC) has always been in controversy. We aimed to assess the prognostic benefits of adjuvant mitotane after resection of ACC in patients without distant metastasis.Methods. The PubMed, WoS, Embase, and Cochrane Library databases were systematically searched. Recurrence-free survival (RFS) and overall survival (OS) were adopted as measurements. A meta-analysis was conducted based on hazard ratio (HR) with 95% confidence interval (CI). A study was included only if the enrolled patients underwent resection of ACC without adjuvant chemotherapy except mitotane.Results. A total of 5 retrospective studies reporting on 1249 patients were included for this meta-analysis. The meta-analysis showed that adjuvant mitotane was significantly associated with prolonged RFS (HR = 0.62; 95%CI, 0.42-0.94; P < 0.05) and prolonged OS (HR = 0.69; 95%CI, 0.55-0.88, P < 0.05).Conclusion. After comprehensive review, current evidence suggests that adjuvant mitotane significantly decreases the recurrence rate and mortality after resection of ACC in patients without distant metastasis, but these findings need further demonstration from prospective controlled trials.

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Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis

BJPsych Open ◽

10.1192/bjo.2021.1003 ◽

2021 ◽

Vol 7 (6) ◽

Author(s):

Shoumitro Deb ◽

Meera Roy ◽

Rachel Lee ◽

Madiha Majid ◽

Bharati Limbu ◽

...

Keyword(s):

Systematic Review ◽

Autism Spectrum Disorder ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Randomised Controlled

Background Although widely used, the current evidence for the efficacy of antidepressant and anti-anxiety medications for people with autism spectrum disorder (ASD) is limited and conflicting. Aims We carried out a systematic review and meta-analysis of randomised controlled trials that assessed the effectiveness of these medications in people with ASD. Method We searched the following databases: Cochrane Library, Medline, EMBASE, CINAHL, PsycINFO, ERIC, DARE and ClinicalTrials.gov. Additionally, we hand-searched 11 relevant journals. We used the Cochrane risk-of-bias tool and Jadad score to assess the quality of each included study. We carried out a meta-analysis using a random effects model. Results We included 15 randomised controlled trials (13 on antidepressants and two on anti-anxiety medications) for a total of 958 people with ASD. Data showed contradictory findings among the studies, with larger studies mostly showing a non-significant difference in outcomes between the treatment and the placebo groups. Meta-analysis of pooled Yale-Brown Obsessive Compulsive Scale and Clinical Global Impression Scale data from nine studies (60%) did not show any statistically significant inter-group difference on either of the outcome measures. The adverse effects reported were mild and, in most studies, their rates did not show any significant inter-group difference. Conclusions Given the methodological flaws in the most included studies and contradictory findings, it is difficult to draw any definitive conclusion about the effectiveness of either antidepressant or anti-anxiety medications to treat either ASD core symptoms or associated behaviours. Robust, large-scale, randomised controlled trials are needed to address this issue.

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The Effects of Cognitive-Based Interventions in Older Adults: A Systematic Review and Meta-Analysis

Iranian Journal of Public Health ◽

10.18502/ijph.v51i1.8286 ◽

2022 ◽

Author(s):

Sunweon Yun ◽

Seang Ryu

Keyword(s):

Older Adults ◽

Cognitive Function ◽

Cognitive Rehabilitation ◽

Nursing Practice ◽

Meta Analysis ◽

Cognitive Stimulation ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Ovid Medline

Background: Cognitive-based intervention is divided into three types: Cognitive Stimulation (CS), Cognitive Training (CT), and Cognitive Rehabilitation (CR). This study was conducted to identify systematically the effects of cognitive-based interventions in randomized controlled trials (RCTs) applied to older adults in the following three groups: cognitively healthy, mild cognitive impairment (MCI), and dementia. Methods: This search was carried out using the Ovid-MEDLINE, EMBASE, Cochrane library, CINAHL, ProQuest, and Korea databases. The effectiveness of the intervention was verified using the CMA 2.0 program. Results: A total of 54 RCTs were included in systematic reviews and 38 studies were analyzed by meta-analysis. Meta-analysis showed that cognitive-based interventions were effective in improving the cognitive function (SMD=0.39, 95% CI=0.32-0.44) of older adults. The subgroup analysis of cognitive function revealed that CT was the most effective in the cognitively healthy (SMD=0.40, 95% CI=0.33-0.46) and the MCI (SMD=0.45, 95% CI=0.27-0.63) groups, and CS was the most effective in the dementia group (SMD=0.57, 95% CI=0.43-0.70). Conclusion: In order to improve the cognitive function of older adults in each group, the most effective intervention type needs to be considered first. Evidence on the appropriate type of Cognitive-based intervention will be helpful in nursing practice.

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Adjunctive Peony-Glycyrrhiza decoction for antipsychotic-induced hyperprolactinaemia: a meta-analysis of randomised controlled trials

General Psychiatry ◽

10.1136/gpsych-2018-100003 ◽

2018 ◽

Vol 31 (1) ◽

pp. e100003 ◽

Cited By ~ 1

Author(s):

Wei Zheng ◽

Dong-Bin Cai ◽

Hai-Yan Li ◽

Yu-Jie Wu ◽

Chee H Ng ◽

...

Keyword(s):

Randomised Controlled Trials ◽

Meta Analysis ◽

Adult Patients ◽

Current Evidence ◽

Cochrane Library ◽

Serum Prolactin ◽

Control Group ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomised Controlled

BackgroundHyperprolactinaemia is a common adverse effect of antipsychotics (APs). The results of Peony-Glycyrrhiza decoction (PGD) as a potentially useful adjunctive treatment for hyperprolactinaemia are inconsistent.AimThis meta-analysis of randomised controlled trials (RCTs) examined the efficacy and safety of adjunctive PGD therapy for AP-induced hyperprolactinaemia.MethodsEnglish (PubMed, Embase, Cochrane Library, PsycINFO) and Chinese (Chinese National Knowledge Infrastructure, Wanfang Data) databases were systematically searched up to 10 June 2018. The inclusion criteria were based on PICOS—Participants: adult patients with schizophrenia; Intervention: PGD plus APs; Comparison: APs plus placebo or AP monotherapy; Outcomes: efficacy and safety; Study design: RCTs. The weighted mean difference (WMD) and risk ratio (RR) along with their 95% CIs were calculated using Review Manager (RevMan) V.5.3 software.ResultsFive RCTs (n=450) were included and analysed. Two RCTs (n=140) were double-blind and four RCTs (n=409) reported ‘random’ assignment with specific description. The PGD group showed a significantly lower serum prolactin level at endpoint than the control group (n=380, WMD: −32.69 ng/mL (95% CI −41.66 to 23.72), p<0.00001, I2=97%). Similarly, the superiority of PGD over the control groups was also found in the improvement of hyperprolactinaemia-related symptoms. No difference was found in the improvement of psychiatric symptoms assessed by the Positive and Negative Syndrome Scale (n=403, WMD: −0.62 (95% CI −2.38 to 1.15), p=0.49, I2=0%). There were similar rates of all-cause discontinuation (n=330, RR 0.93 (95% CI 0.63 to 1.37), p=0.71, I2=0%) and adverse drug reactions between the two groups. According to the Grading of Recommendations Assessment, Development and Evaluation approach, the level of evidence of primary and secondary outcomes ranged from ‘very low’ (14.3%), ‘low’ (42.8%), ‘moderate’ (14.3%), to ‘high’ (28.6%).ConclusionsCurrent evidence supports the adjunctive use of PGD to suppress elevated prolactin and improve prolactin-induced symptoms without significant adverse events in adult patients with AP-induced hyperprolactinaemia. High-quality RCTs with longer duration are needed to confirm these findings.Trial registration number42016037017.

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