In an empirical evaluation of the funnel plot, researchers could not visually identify publication bias

Core GRADE 4: rating certainty of evidence-risk of bias, publication bias, and reasons for rating up certainty

This fourth article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to addressing risk of bias, publication bias, and rating up certainty. In Core GRADE, randomised controlled trials begin as high certainty evidence and non-randomised studies of interventions (NRSI) as low certainty. To assess certainty of evidence for risk of bias, Core GRADE users first classify individual studies as low or high risk of bias. Decisions regarding rating down for risk of bias will depend on the weights of high and low risk of bias studies and similarities or differences between the results of high and low risk of bias studies. For publication bias, a body of evidence comprising small studies funded by industry should raise suspicion. Core GRADE users appraising results from well conducted NSRI can consider rating up certainty of evidence when risk ratios from pooled estimates suggest large or very large effects.

Optimal timing for lumen-apposing metal stent removal following endoscopic ultrasound-guided drainage of pancreatic fluid collections: a systematic review and meta-analysis

BACKGROUND

 Lumen-apposing metal stents (LAMSs) are widely used for endoscopic ultrasound (EUS)-guided drainage of pancreatic fluid collections (PFCs). Safety is a major concern and the timing of LAMS removal is debated owing to the risk of adverse events (AEs). Previous studies showed early stent removal was associated with a reduced risk of AEs, but data are still conflicting. The aim of this systematic review with meta-analysis was to identify the optimal timing for LAMS removal.

METHODS

 Major databases were systematically searched until May 2024. The outcome assessed was the cumulative incidence of AEs related to the early (within 3-4 weeks) versus late (after 3-4 weeks) removal of the LAMS. A random-effects (DerSimonian-Laird) model was used to pool the results.

RESULTS

 Eight studies (1820 patients; mean age 54-61.6 years; 63 % men) were included in the analysis. PFCs included walled-off necrosis (WON; 58.2 %) and pseudocysts (41.8 %). Pooled LAMS-related AEs rate were similar in the late versus early removal groups (risk ratio [RR] 1.03, 95 %CI 0.47-2.28; P = 0.94). Sensitivity analysis, including only studies applying a 4-week cut-off, confirmed a comparable AEs rate (RR 0.80, 95 %CI 0.38-1.65; P = 0.59). The mean (SD) follow-up of the studies was 208 (88) days.

CONCLUSIONS

 The results of this meta-analysis showed no difference in the incidence of AEs between early and late removal of LAMSs in the presence of moderate heterogeneity across studies. Removal within 4 weeks is not warranted, and it may instead be planned on a clinical case-by-case basis according on the patient's condition.

Methodologies for network meta-analysis of randomised controlled trials in pain, anaesthesia, and perioperative medicine: a narrative review

Network meta-analysis has emerged as a method for analysing clinical trials, with a large increase in the number of publications over the past decade. Network meta-analysis offers advantages over traditional pairwise meta-analysis, including increased power, the ability to compare treatments not compared in the original trials, and the ability to rank treatments. However, network meta-analyses are inherently more complex than pairwise meta-analyses, requiring additional statistical expertise and assumptions. Many factors can affect the certainty of evidence from pairwise meta-analysis and can often lead to unreliable results. Network meta-analysis is prone to all these issues, although it has the additional assumption of transitivity. Here we review network meta-analyses, problems with their conduct and reporting, and methodological strategies that can be used by those conducting reviews to help improve the reliability of their findings. We provide evidence that violation of the assumption of transitivity is relatively common and inadequately considered in published network meta-analyses. We explain key concepts with clinically relevant examples for those unfamiliar with network meta-analysis to facilitate their appraisal and application of their results to clinical practice.

Gender-neutral vs. gender-specific strategies in school-based HPV vaccination programs: a systematic review and meta-analysis

Introduction

This systematic review and meta-analysis evaluated whether gender-neutral (GN) or gender-specific (GS) strategies more effectively enhanced knowledge, intention, and uptake of HPV vaccination among students in educational settings.

Methods

A comprehensive literature search of PubMed, Scopus, Web of Science, and Cochrane Library identified 17 randomized controlled trials encompassing 22,435 participants (14,665 females, 7,770 males). Random-effects models were used to calculate standardized mean differences (SMDs) for knowledge and intention, and risk differences for vaccination uptake.

Results

GN strategies achieved higher improvements in knowledge (SMD = 0.95) and intention (SMD = 0.59) compared with GS (SMD = 0.68 for knowledge, SMD = 0.14 for intention), and displayed a greater increase in uptake (5.7% versus 2.5% in GS), although this uptake difference was not statistically significant. Heterogeneity was more pronounced for knowledge outcomes and moderate for GS uptake results.

Discussion

Despite GN approaches seemingly offering more robust enhancements in HPV-related knowledge and vaccination intention, additional research with robust designs and longer follow-up is required to determine whether GN interventions definitively outperform GS strategies in achieving statistically significant increases in actual vaccination uptake.

A meta-analysis of the impact of TOE adoption on smart agriculture SMEs performance

BACKGROUND

Agricultural SMEs face distinct challenges due to factors such as weather, climate change, and commodity price changes. Technology has become essential in helping SMEs overcome these challenges and grow their businesses. The relationship between technology and SMEs in the agriculture sector covers various aspects, such as using hardware and software, digital applications, sensors, and e-commerce strategies to be examined in further depth through literature study.

PROBLEM STATEMENT

The implementation of the TOE (technology, organization, and environment) framework in smart agriculture faces several challenges. To overcome these challenges, an integrated approach is needed that involves technological capacity building, organizational management changes, and adequate policy and infrastructure support to help SMEs in the agricultural sector develop their businesses.

OBJECTIVES

This research aims to demonstrate and identify how TOE plays an important role in the performance of SMEs, particularly with regard to agriculture in order to improve agricultural productivity, efficiency, and sustainability while enabling access to broader markets in several countries. This study employs a meta-analysis method using a quantitative approach taken by each publication, which typically used SEM.

METHODS

PRISMA technique was used to examine evidence from clinical trials, and clinical significance was determined using the GRADE approach. Statistical analysis was performed using the Fisher test to combine the results of several studies and Cohen's approach to interpreting effect sizes.

FINDINGS

The results of this study are in line with the findings of 27 previous studies which showed a direct positive relationship between TOE construction and the performance of agricultural SMEs, with variables including technological factors, organizational factors, environmental factors, and SME performance. The synergy between technology adoption by agricultural SMEs and Industry 4.0 can increase connectivity and automation in the agricultural sector. However, it is important to remember that adopting TOE to realize the smart agriculture concept has its own challenges and risks, such as resource management (technology), good organizational management (organization), and internal and external organizational environments (environments), including intense competition.

RESEARCH IMPLICATION

TOE adoption improves access to information about competitors and customers, providing practitioners and decision-makers with a clearer understanding. It enables focus on factors with a significant impact on TOE adoption, so that they are more independent in developing effective business concepts that are adaptive to the era of agricultural technology 4.0.

Review article: Electronic screening and brief intervention for alcohol-related trauma: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to evaluate the effectiveness of Electronic Screening and Brief Intervention (e-SBI) in changing or reducing alcohol consumption and/or related risk behaviours among trauma patients compared to standard of care. Following Cochrane Collaboration's guidelines and PRISMA recommendations, a search of electronic databases (MEDLINE via PubMed, CINAHL, Scopus and Web of Science) and grey literature (Google Scholar) was conducted. Randomised controlled trials (RCTs) from 1995 to 2023 were included, focusing on e-SBI for alcohol misuse in trauma patients. Quality assessment utilised the Cochrane risk of bias tool. Bayesian meta-analysis was employed for synthesising outcomes. Four RCTs, totalling 2641 participants, were included. While e-SBI demonstrated a significant reduction in problematic alcohol consumption up to 6 months post-implementation, uncertainties were noted in risk behaviours determined by: average alcohol consumption, binge drinking and alcohol-related consequences. Heterogeneity in measurements and population variations contributed to the nuanced findings. The review suggests that e-SBI may be effective in reducing problematic alcohol consumption in the short term among alcohol-related trauma patients. However, uncertainties and methodological variations highlight the need for standardised outcome measurements, consistent reporting and further exploration of e-SBI's long-term impact. Relevance to health promotion: Understanding the effectiveness of e-SBI in managing alcohol-related issues among trauma patients is crucial for health promotion. Despite uncertainties, the findings underscore the potential of e-SBI as a scalable and accessible intervention. e-SBI in the setting of the present study, emphasises the importance of tailored approaches in public health strategies.

Immune response of COVID-19 vaccines in solid cancer patients: A meta-analysis

Solid cancer patients, compared to their healthy counterparts, are at a greater risk of contracting and suffering from severe complications and poorer prognosis after COVID-19 infections. They also have different immune responses after doses of COVID-19 vaccination, but limited evidence is available to reveal the effectiveness and help to guide immunization programs for this subpopulation; MEDLINE, Embase, Web of Science, Cochrane Library databases, and clinicaltrials.gov were used to search literature. The pooled seroconversion rate was calculated using a random-effects model and reported with a 95% confidence interval (CI); The review includes 66 studies containing serological responses after COVID-19 vaccination in 13,050 solid cancer patients and 8550 healthy controls. The pooled seropositive rates after the first dose in patients with solid cancer and healthy controls are 55.2% (95% CI 45.9%-64.5% N = 18) and 90.2% (95% CI 80.9%-96.6% N = 13), respectively. The seropositive rates after the second dose in patients with solid cancer and healthy controls are 87.6% (95% CI 84.1%-90.7% N = 50) and 98.9% (95% CI 97.6%-99.7% N = 35), respectively. The seropositive rates after the third dose in patients with solid cancer and healthy controls are 91.4% (95% CI 85.4%-95.9% N = 21) and 99.8% (95% CI 98.1%-100.0% N = 4), respectively. Subgroup analysis finds that study sample size, timing of antibody testing, and vaccine type have influence on the results; Seroconversion rates after COVID-19 vaccination are significantly lower in patients with solid malignancies, especially after the first dose, then shrinking gradually after the following two vaccinations, indicating that subsequent doses or a booster dose should be considered for the effectiveness of this subpopulation.

Assessment of inverse publication bias in safety outcomes: an empirical analysis

BACKGROUND

The aims of this study were to assess the presence of inverse publication bias (IPB) in adverse events, evaluate the performance of visual examination, and explore the impact of considering effect direction in statistical tests for such assessments.

METHODS

We conducted a cross-sectional study using the SMART Safety, the largest dataset for evidence synthesis of adverse events. The visual assessment was performed using contour-enhanced funnel plots, trim-and-fill funnel plots, and sample-size-based funnel plots. Two authors conducted visual assessments of these plots independently, and their agreements were quantified by the kappa statistics. Additionally, IPB was quantitatively assessed using both the one- and two-sided Egger's and Peters' tests.

RESULTS

In the SMART Safety dataset, we identified 277 main meta-analyses of safety outcomes with at least 10 individual estimates after dropping missing data. We found that about 13.7-16.2% of meta-analyses exhibited IPB according to the one-sided test results. The kappa statistics for the visual assessments roughly ranged from 0.3 to 0.5, indicating fair to moderate agreement. Using the one-sided Egger's test, 57 out of 72 (79.2%) meta-analyses that initially showed significant IPB in the two-sided test changed to non-significant, while the remaining 15 (20.8%) meta-analyses changed from non-significant to significant.

CONCLUSIONS

Our findings provide supporting evidence of IPB in the SMART Safety dataset of adverse events. They also suggest the importance of researchers carefully accounting for the direction of statistical tests for IPB, as well as the challenges of assessing IPB using statistical methods, especially considering that the number of studies is typically small. Qualitative assessments may be a necessary supplement to gain a more comprehensive understanding of IPB.

Radiomics in distinguishing between lung adenocarcinoma and lung squamous cell carcinoma: a systematic review and meta-analysis

Objectives

The aim of this study was to systematically review the studies on radiomics models in distinguishing between lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) and evaluate the classification performance of radiomics models using images from various imaging techniques.

Materials and methods

PubMed, Embase and Web of Science Core Collection were utilized to search for radiomics studies that differentiate between LUAD and LUSC. The assessment of the quality of studies included utilized the improved Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Radiomics Quality Score (RQS). Meta-analysis was conducted to assess the classification performance of radiomics models using various imaging techniques.

Results

The qualitative analysis included 40 studies, while the quantitative synthesis included 21 studies. Median RQS for 40 studies was 12 (range -5~19). Sixteen studies were deemed to have a low risk of bias and low concerns regarding applicability. The radiomics model based on CT images had a pooled sensitivity of 0.78 (95%CI: 0.71~0.83), specificity of 0.85 (95%CI:0.73~0.92), and the area under summary receiver operating characteristic curve (SROC-AUC) of 0.86 (95%CI:0.82~0.89). As for PET images, the pooled sensitivity was 0.80 (95%CI: 0.61~0.91), specificity was 0.77 (95%CI: 0.60~0.88), and the SROC-AUC was 0.85 (95%CI: 0.82~0.88). PET/CT images had a pooled sensitivity of 0.87 (95%CI: 0.72~0.94), specificity of 0.88 (95%CI: 0.80~0.93), and an SROC-AUC of 0.93 (95%CI: 0.91~0.95). MRI images had a pooled sensitivity of 0.73 (95%CI: 0.61~0.82), specificity of 0.80 (95%CI: 0.65~0.90), and an SROC-AUC of 0.79 (95%CI: 0.75~0.82).

Conclusion

Radiomics models demonstrate potential in distinguishing between LUAD and LUSC. Nevertheless, it is crucial to conduct a well-designed and powered prospective radiomics studies to establish their credibility in clinical application.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=412851, identifier CRD42023412851.

Prevalence of spontaneous movement disorders (dyskinesia, parkinsonism, akathisia and dystonia) in never-treated patients with chronic and first-episode psychosis: a systematic review and meta-analysis

BACKGROUND

The aim of this systematic review and meta-analysis is to evaluate and compare the prevalence rates of spontaneous movement disorders (SMDs), including dyskinesia, parkinsonism, akathisia and dystonia, in antipsychotic-naïve individuals with chronic psychosis and first-episode psychosis (FEP) and gain a more nuanced understanding of factors influencing their presence.

METHODS

Several literature databases were systematically searched and screened based on predetermined eligibility criteria. Included articles underwent risk of bias assessment. The prevalence rates of SMDs were calculated using a random-effects model.

RESULTS

Out of 711 articles screened, 27 were included in this meta-analysis. The pooled prevalence of spontaneous dyskinesia was 7% (3% FEP and 17% chronic schizophrenia) across 24 studies (95% CI 3 to 11; I2=94%, p<0.01) and 15% for spontaneous parkinsonism (14% FEP and 19% chronic schizophrenia) in 21 studies (95% CI 12 to 20; I2=81%, p<0.01). A meta-regression analysis found a significant positive correlation between age (p<0.05) and duration of untreated psychosis (DUP) (p<0.05) with dyskinesia but not parkinsonism prevalence. Akathisia and dystonia appear to be both less studied and less frequent in occurrence with a pooled prevalence of 4% (95% CI: 3 to 6; I2=0%, p=0.65) for akathisia in eight studies and a mean prevalence of 6% (range 0%-16%) for dystonia in five studies.

CONCLUSION

The presence of varying degrees of neurodysfunction in antipsychotic-naïve patients with schizophrenia underscores the need for individualised treatment approaches that consider each patient's unique predisposition and neuromotor profile. Further research is warranted into the role of specific SMDs and risk factors including sex, race and diagnostic variations.

PROSPERO REGISTRATION NUMBER

CRD42024501951.

LFK index does not reliably detect small-study effects in meta-analysis: A simulation study

The LFK index has been promoted as an improved method to detect bias in meta-analysis. Putatively, its performance does not depend on the number of studies in the meta-analysis. We conducted a simulation study, comparing the LFK index test to three standard tests for funnel plot asymmetry in settings with smaller or larger group sample sizes. In general, false positive rates of the LFK index test markedly depended on the number and size of studies as well as the between-study heterogeneity with values between 0% and almost 30%. Egger's test adhered well to the pre-specified significance level of 5% under homogeneity, but was too liberal (smaller groups) or conservative (larger groups) under heterogeneity. The rank test was too conservative for most simulation scenarios. The Thompson-Sharp test was too conservative under homogeneity, but adhered well to the significance level in case of heterogeneity. The true positive rate of the LFK index test was only larger compared with classic tests if the false positive rate was inflated. The power of classic tests was similar or larger than the LFK index test if the false positive rate of the LFK index test was used as significance level for the classic tests. Under ideal conditions, the false positive rate of the LFK index test markedly and unpredictably depends on the number and sample size of studies as well as the extent of between-study heterogeneity. The LFK index test in its current implementation should not be used to assess funnel plot asymmetry in meta-analysis.

Efficacy and Safety of Hydrocortisone, Ascorbic Acid, and Thiamine Combination Therapy for the Management of Sepsis and Septic Shock: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

INTRODUCTION

This systematic review aimed to assess the efficacy and safety of hydrocortisone, ascorbic acid, and thiamine (HAT) combination therapy in patients with sepsis and septic shock.

METHODS

We conducted a database search in MEDLINE, Embase, CENTRAL, Web of Science, and CNKI for randomised controlled trials (RCTs) comparing HAT against placebo/standard of care or against hydrocortisone in sepsis/septic shock patients. Outcomes included mortality, ICU/hospital length of stay (LOS), vasopressor durations, mechanical ventilation durations, change in SOFA at 72 h, and adverse events. RCT results were pooled in random-effects meta-analyses. Quality of evidence was assessed using GRADE.

RESULTS

Fifteen RCTs (N = 2,594) were included. At 72 h, HAT reduced SOFA scores from baseline (mean difference [MD] -1.16, 95% confidence interval [CI]: -1.58 to -0.74, I2 = 0%) compared to placebo/SoC, based on moderate quality of evidence. HAT also reduced the duration of vasopressor use (MD -18.80 h, 95% CI: -23.67 to -13.93, I2 = 64%) compared to placebo/SoC, based on moderate quality of evidence. HAT increased hospital LOS (MD 2.05 days, 95% CI: 0.15-3.95, I2 = 57%) compared to placebo/SoC, based on very low quality of evidence. HAT did not increase incidence of adverse events compared to placebo/SoC.

CONCLUSIONS

HAT appears beneficial in reducing vasopressor use and improving organ function in sepsis/septic shock patients. However, its advantages over hydrocortisone alone remain unclear. Future research should use hydrocortisone comparators and distinguish between sepsis-specific and comorbidity- or care-withdrawal-related mortality.

Relationship between rate of glucose or propionate infusion and milk protein yield and concentration in dairy cows: A meta-regression

Although postruminal glucose infusion into dairy cows has increased milk protein yield in some past experiments, the same trend has not been observed in others. A meta-regression of 64 sets of observations from 29 previously published glucose and propionate infusion studies in dairy cattle, treating study and experiment (study) as random effects, was performed to establish the general effects of glucose equivalent (GlcE) infusion rate on milk true protein (MTP) yield and content, if any, and to identify independent, fixed-effect variables that accounted for the changes in MTP yield and content that were observed. Candidate explanatory variables included rate and site of infusion, diet composition and intake, body weight and lactation stage of the cows, and the change in nutrient intake between GlcE and control treatments. Across all studies, according to a model containing only the random effects of study and experiment, GlcE infusion at an average of 954 g/d increased MTP yield by 26 g/d, on average, whereas mean MTP content was not affected. Backward stepwise elimination of potential explanatory variables from a full mixed model produced a final, reduced model for MTP yield that retained a positive, second-order quadratic effect of infusion rate of GlcE and a positive, linear effect of the change in crude protein intake (CPI) between GlcE treatment and control. This change in CPI due to GlcE infusion ranged from -0.546 to 0.173 kg/d in the dataset. The model fit indicated that when CPI was allowed to drop during GlcE infusion, the effect of GlcE on MTP yield was smaller than when CPI was maintained or increased, in a manifestation of the classic protein:energy interaction. The final reduced model for MTP content contained the same explanatory variables as for MTP yield, plus a negative effect of intravenous compared with gastrointestinal infusion. Overall, the meta-analysis revealed that both MTP yield, and content were positively related to GlcE infusion rate and to the change in CPI between glucose treatment and control.

Quadratus Lumborum Block and Transversus Abdominis Plane Block in Non-emergency Cesarean Delivery: A Systematic Review and Meta-analysis

PURPOSE

Investigate the analgesic efficacy of quadratus lumborum (QL) block versus transversus abdominis plane (TAP) block in postoperative pain management in nonemergent cesarean section.

DESIGN

Systematic review with meta-analysis.

METHODS

PubMed, Cochrane, CINAHL, Google Scholar, and gray literature were searched for evidence. Only randomized controlled trials examining the effects of QL and TAP block for nonemergent cesarean delivery were included. Mean difference (MD) was used to estimate continuous outcomes with appropriate effect models. The quality of evidence was rated using the Risk of Bias and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system.

FINDINGS

Six studies involving 543 parturients were included. Compared to the TAP block, the cumulative 24-hour pain score at rest (MD, -0.60; 95% CI, -1.03 to -0.17; P = .007) and during activity (MD, -1.05; 95% CI, -1.54 to -0.56; P < .0001) were significantly lower in QL block. Time to the first analgesic rescue (MD, 21.67; 95% CI, -18.58 to 61.91; P = .29) and opioid consumption (MD, -1.96; 95% CI, -4.59 to 0.66; P = .14) were similar in both groups. No difference was found in the incidence of postoperative nausea and vomiting and sedation. However, patients treated with QL block reported higher patient satisfaction scores.

CONCLUSIONS

There is limited evidence to suggest that QL block is superior to TAP block for postoperative pain management in nonemergent cesarean delivery. The study limitations must be considered when extrapolating the review's findings to clinical practice.

A Review of Meta-Analyses in Plastic Surgery: Need for Adequate Assessment of Publication Bias

INTRODUCTION

Publication bias describes a phenomenon in which significant positive results have a higher likelihood of being published compared to negative or nonsignificant results. Publication bias can confound the estimated therapeutic effect in meta-analyses and needs to be adequately assessed in the surgical literature.

METHODS

A review of meta-analyses published in five plastic surgery journals from 2002 to 2022 was conducted. The inclusion criteria for meta-analyses were factors that demonstrated an obligation to assess publication bias, such as interventions with comparable treatment groups and enough power for statistical analysis. Acknowledgment of publication bias risk, quality of bias assessment, methods used in assessment, and individual article factors were analyzed.

RESULTS

318 unique meta-analyses were identified in literature search, and after full-text reviews, 143 met the inclusion criteria for obligation to assess publication bias. 64% of eligible meta-analyses acknowledged the confounding potential of publication bias, and only 46% conducted a formal assessment. Of those who conducted an assessment, 49% used subjective inspection of funnel plots alone, while 47% used any statistical testing in analysis. Overall, only 9/143 (6.3%) assessed publication bias and attempted to correct for its effect. Journals with a higher average impact factor were associated with mention and assessment of publication bias, but more recent publication year and higher number of primary articles analyzed were not.

CONCLUSIONS

This review identified low rates of proper publication bias assessment in meta-analyses published in five major plastic surgery journals. Assessment of publication bias using objective statistical testing is necessary to ensure quality literature within surgical disciplines.

Incidence of second primary cancers in patients with retinoblastoma: a systematic review and meta-analysis

Introduction

This systematic review and meta-analysis aimed to examine the risk of second primary cancers (SPCs) among retinoblastoma (Rb) patients, both hereditary and nonhereditary. Previous studies have reported on the long-term risk of SPCs in these patient populations, but a comprehensive synthesis of the existing evidence is lacking.

Methods

A systematic search was conducted in PubMed, EMBASE, and Cochrane Library from inception to 12 March 2023, supplemented by manual screening. Eligible studies were identified, and data were extracted. The primary outcome measure was the standardized incidence ratios (SIRs) of SPCs in Rb patients. Summary estimates were calculated using random or fixed effects models. The quality of included studies was assessed using the Newcastle-Ottawa Scale.

Results

Ten studies, including nine high-quality studies, were included in this review. The summary estimate of SIR for SPCs among hereditary Rb patients was 17.55 (95% CI=13.10-23.51), while the pooled estimate of SIR for SPCs among nonhereditary Rb patients was 1.36 (95% CI=0.90-2.04). Significant differences in SIRs for different SPC types were observed (P=0.028), including nasal cavity tumor (SIR=591.06, 95% CI=162.79-2146.01), bone tumor (SIR=442.91, 95% CI=191.63-1023.68), soft tissue sarcoma (SIR=202.93, 95% CI=114.10-360.93), CNS (SIR=12.84, 95% CI=8.80-18.74), and female breast cancer (SIR=3.68, 95% CI=2.52-5.37). Chemotherapy and radiation therapy were associated with an increased risk of SPCs among hereditary Rb patients.

Discussion

The findings of this review indicate that hereditary Rb patients have a significantly elevated risk of developing SPCs, whereas nonhereditary Rb patients do not show the same risk. Furthermore, significant differences were observed in the SIRs of different SPC types. Treatment techniques, specifically chemotherapy and radiation therapy, were associated with an increased risk of SPCs among hereditary Rb patients. These findings highlight the importance of radiation protection for Rb patients and the need for further research and tailored management strategies for this high-risk population.

Variation observed in consensus judgments between pairs of reviewers when assessing the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research

OBJECTIVES

To evaluate the risk of bias due to missing evidence in a sample of published meta-analyses of nutrition research using the Risk Of Bias due to Missing Evidence (ROB-ME) tool and determine inter-rater agreement in assessments.

STUDY DESIGN AND SETTING

We assembled a random sample of 42 meta-analyses of nutrition research. Eight assessors were randomly assigned to one of four pairs. Each pair assessed 21 randomly assigned meta-analyses, and each meta-analysis was assessed by two pairs. We calculated raw percentage agreement and chance corrected agreement using Gwet's Agreement Coefficient (AC) in consensus judgments between pairs.

RESULTS

Across the eight signaling questions in the ROB-ME tool, raw percentage agreement ranged from 52% to 100%, and Gwet's AC ranged from 0.39 to 0.76. For the risk-of-bias judgment, the raw percentage agreement was 76% (95% confidence interval 60% to 92%) and Gwet's AC was 0.47 (95% confidence interval 0.14 to 0.80). In seven (17%) meta-analyses, either one or both pairs judged the risk of bias due to missing evidence as "low risk".

CONCLUSION

Our findings indicated substantial variation in assessments in consensus judgments between pairs for the signaling questions and overall risk-of-bias judgments. More tutorials and training are needed to help researchers apply the ROB-ME tool more consistently.

The Perils of Misinterpreting and Misusing "Publication Bias" in Meta-analyses: An Education Review on Funnel Plot-Based Methods

Publication bias refers to a systematic deviation from the truth in the results of a meta-analysis due to the higher likelihood for published studies to be included in meta-analyses than unpublished studies. Publication bias can lead to misleading recommendations for decision and policy making. In this education review, we introduce, explain, and provide solutions to the pervasive misuses and misinterpretations of publication bias that afflict evidence syntheses in sport and exercise medicine, with a focus on the commonly used funnel-plot based methods. Publication bias is more routinely assessed by visually inspecting funnel plot asymmetry, although it has been consistently deemed unreliable, leading to the development of statistical tests to assess publication bias. However, most statistical tests of publication bias (i) cannot rule out alternative explanations for funnel plot asymmetry (e.g., between-study heterogeneity, choice of metric, chance) and (ii) are grossly underpowered, even when using an arbitrary minimum threshold of ten or more studies. We performed a cross-sectional meta-research investigation of how publication bias was assessed in systematic reviews with meta-analyses published in the top two sport and exercise medicine journals throughout 2021. This analysis highlights that publication bias is frequently misused and misinterpreted, even in top tier journals. Because of conceptual and methodological problems when assessing and interpreting publication bias, preventive strategies (e.g., pre-registration, registered reports, disclosing protocol deviations, and reporting all study findings regardless of direction or magnitude) offer the best and most efficient solution to mitigate the misuse and misinterpretation of publication bias. Because true publication bias is very difficult to determine, we recommend that future publications use the term "risk of publication bias".

Exploring open science practices in behavioural public policy research

In their book 'Nudge: Improving Decisions About Health, Wealth and Happiness', Thaler & Sunstein (2009) argue that choice architectures are promising public policy interventions. This research programme motivated the creation of 'nudge units', government agencies which aim to apply insights from behavioural science to improve public policy. We closely examine a meta-analysis of the evidence gathered by two of the largest and most influential nudge units (DellaVigna & Linos (2022 Econometrica 90, 81-116 (doi:10.3982/ECTA18709))) and use statistical techniques to detect reporting biases. Our analysis shows evidence suggestive of selective reporting. We additionally evaluate the public pre-analysis plans from one of the two nudge units (Office of Evaluation Sciences). We identify several instances of excellent practice; however, we also find that the analysis plans and reporting often lack sufficient detail to evaluate (unintentional) reporting biases. We highlight several improvements that would enhance the effectiveness of the pre-analysis plans and reports as a means to combat reporting biases. Our findings and suggestions can further improve the evidence base for policy decisions.

Evaluating fluvoxamine for the outpatient treatment of COVID-19: A systematic review and meta-analysis

This systematic review and meta-analysis of randomised controlled trials (RCTs) aimed to evaluate the efficacy, safety, and tolerability of fluvoxamine for the outpatient management of COVID-19. We conducted this review in accordance with the PRISMA 2020 guidelines. Literature searches were conducted in MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, Web of Science, and CENTRAL up to 14 September 2023. Outcomes included incidence of hospitalisation, healthcare utilization (emergency room visits and/or hospitalisation), mortality, supplemental oxygen and mechanical ventilation requirements, serious adverse events (SAEs) and non-adherence. Fluvoxamine 100 mg twice a day was associated with reductions in the risk of hospitalisation (risk ratio [RR] 0.75, 95% confidence interval [CI] 0.58-0.97; I 2  = 0%) and reductions in the risk of healthcare utilization (RR 0.68, 95% CI 0.53-0.86; I 2  = 0%). While no increased SAEs were observed, fluvoxamine 100 mg twice a day was associated with higher treatment non-adherence compared to placebo (RR 1.61, 95% CI 1.22-2.14; I 2  = 53%). In subgroup analyses, fluvoxamine reduced healthcare utilization in outpatients with BMI ≥30 kg/m2 , but not in those with lower BMIs. While fluvoxamine offers potential benefits in reducing healthcare utilization, its efficacy may be most pronounced in high-risk patient populations. The observed non-adherence rates highlight the need for better patient education and counselling. Future investigations should reassess trial endpoints to include outcomes relating to post-COVID sequelaes. Registration: This review was prospectively registered on PROSPERO (CRD42023463829).

Maternal exposure to SSRIs or SNRIs and the risk of congenital abnormalities in offspring: A systematic review and meta-analysis

BACKGROUND

The association of maternal exposure to selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) with the risk of system-specific congenital malformations in offspring remains unclear. We conducted a meta-analysis to examine this association and the risk difference between these two types of inhibitors.

METHODS

A literature search was performed from January 2000 to May 2023 using PubMed and Web of Science databases. Cohort and case-control studies that assess the association of maternal exposure to SSRIs or SNRIs with the risk of congenital abnormalities were eligible for the study.

RESULTS

Twenty-one cohort studies and seven case-control studies were included in the meta-analysis. Compared to non-exposure, maternal exposure to SNRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.64 with 95% CI: 1.36, 1.97), anomalies of the kidney and urinary tract (pooled OR: 1.63 with 95% CI: 1.21, 2.20), malformations of nervous system (pooled OR: 2.28 with 95% CI: 1.50, 3.45), anomalies of digestive system (pooled OR: 2.05 with 95% CI: 1.60, 2.64) and abdominal birth defects (pooled OR: 2.91 with 95%CI: 1.98, 4.28), while maternal exposure to SSRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.25 with 95%CI: 1.20, 1.30), anomalies of the kidney and urinary tract (pooled OR: 1.14 with 95%CI: 1.02, 1.27), anomalies of digestive system (pooled OR: 1.11 with 95%CI: 1.01, 1.21), abdominal birth defects (pooled OR: 1.33 with 95%CI: 1.16, 1.53) and musculoskeletal malformations (pooled OR: 1.44 with 95%CI: 1.32, 1.56).

CONCLUSIONS

SSRIs and SNRIs have various teratogenic risks. Clinicians must consider risk-benefit ratios and patient history when prescribing medicines.

Evaluation of accuracy between extraoral Gothic arch tracing and various other methods assessing horizontal condylar guidance angle in completely edentulous patients: A systematic review and meta-analysis

Aim

The aim of this systematic review and meta-analysis was to determine the accuracy of different methods of measuring horizontal condylar guidance (HCG) angle in comparison with extraoral Gothic arch tracing for completely edentulous patients.

Settings and Design

This was a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Materials and Methods

Two reviewers searched the EBSCOhost, Cochrane Library, and PubMed/MEDLINE databases and the Google Scholar search engine for in vivo studies, randomized controlled trials, cross-sectional studies, and quasi-experimental studies published from January 2005 to December 2022 on various other methods of determining HCG angle in completely edentulous patients compared with extraoral Gothic arch tracing method.

Statistical Analysis Used

Meta-analysis was conducted from the reported quantitative data.

Results

A total of 513 articles were obtained from different electronic databases, of which 22 studies were included for qualitative synthesis and 20 studies were included for meta-analysis. For the right side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.08 [2.17, 7]) and cephalogram (P < 0.05, pooled mean difference = 10.65 [8.81, 12.49]), whereas no statistically significant difference was observed for cone-beam computed tomography (CBCT) (P = 0.41, pooled mean difference = 4.39 [-6.10, 14.87]) and protrusive interocclusal wax record (P = 0.92, pooled mean difference = -0.45 [-9.62, 8.72]) as compared with extraoral Gothic arch tracing method. For the left side, a statistically significant difference was observed for panoramic radiograph (P < 0.05, pooled mean difference = 5.07 [1.95, 8.18]) and cephalogram (P < 0.05, pooled mean difference = 10.24 [8.65, 11.83]), whereas no statistically significant difference was observed for CBCT (P = 0.31, pooled mean difference = 4.05 [-3.74, 11.84]) and protrusive interocclusal wax record (P = 0.72, pooled mean difference = -1.21 [-7.86, 5.43]) as compared with extraoral Gothic arch tracing method.

Conclusion

The cephalogram and panoramic radiograph obtained higher HCG angles in completely edentulous patients than extraoral Gothic arch tracing.

Therapeutic potential of senolytic agent quercetin in osteoarthritis: A systematic review and meta-analysis of preclinical studies

BACKGROUND

Quercetin, a natural flavonoid, has shown promise as a senolytic agent for various degenerative diseases. Recently, its protective effect against osteoarthritis (OA), a representative age-related disease of the musculoskeletal system, has attracted much attention. The aim of this study is to summarize and analyze the current literature on the effects of quercetin on OA cartilage in in vivo preclinical studies.

METHODS

The Medline (via/using PubMed), Embase, and Web of Science databases were searched up to March 10th, 2023. Risk of bias and the qualitative assessment including mechanisms of all eligible studies and a meta-analysis of cartilage histological scores among the applicable studies was performed.

RESULTS

A total of 12 in vivo animal studies were included in this systematic review. A random-effects meta-analysis was performed on six studies using the Osteoarthritis Research Society International (OARSI) scoring system, revealing that quercetin significantly improved OA cartilage OARSI scores (SMD, -6.30 [95% CI, -9.59 to -3.01]; P = 0.0002; heterogeneity: I2 = 86%). The remaining six studies all supported quercetin's protective effects against OA during disease and aging.

CONCLUSIONS

Quercetin has shown beneficial effects on cartilage during OA across animal species. Future double-blind randomized controlled clinical trials are needed to verify the efficacy of quercetin in the treatment of OA in humans.

Functional Family Therapy for families of youth (age 11-18) with behaviour problems: A systematic review and meta-analysis

Background

Functional Family Therapy (FFT) is a short-term family-based intervention for youth with behaviour problems. FFT has been widely implemented in the USA and other high-income countries. It is often described as an evidence-based program with consistent, positive effects.

Objectives

We aimed to synthesise the best available data to assess the effectiveness of FFT for families of youth with behaviour problems.

Search Methods

Searches were performed in 2013-2014 and August 2020. We searched 22 bibliographic databases (including PsycINFO, ERIC, MEDLINE, Science Direct, Sociological Abstracts, Social Services Abstracts, World CAT dissertations and theses, and the Web of Science Core Collection), as well as government policy databanks and professional websites. Reference lists of articles were examined, and experts were contacted to search for missing information.

Selection Criteria

We included randomised controlled trials (RCTs) and quasi-experimental designs (QEDs) with parallel cohorts and statistical controls for between-group differences at baseline. Participants were families of young people aged 11-18 with behaviour problems. FFT programmes were compared with usual services, alternative treatment, and no treatment. There were no publication, geographic, or language restrictions.

Data Collection and Analysis

Two reviewers independently screened 1039 titles and abstracts, read all available study reports, assessed study eligibility, and extracted data onto structured electronic forms. We assessed risks of bias (ROB) using modified versions of the Cochrane ROB tool and the What Works Clearinghouse standards. Where possible, we used random effects models with inverse variance weights to pool results across studies. We used odds ratios for dichotomous outcomes and standardised mean differences for continuous outcomes. We used Hedges g to adjust for small sample sizes. We assessed the heterogeneity of effects with χ 2 and I 2. We produced separate forest plots for conceptually distinct outcomes and for different endpoints (<9, 9-14, 15-23, and 24-42 months after referral). We grouped studies by study design (RCT or QED), and then assessed differences between these two subgroups of studies with χ 2 tests. We generated robust variance estimates, using correlated effects (CE) models with small sample corrections to synthesise all available outcome data. Exploratory CE analyses assessed potential moderators of effects within these domains. We used GRADE guidelines to assess the certainty of evidence on six primary outcomes at 1 year after referral.

Main Results

Twenty studies (14 RCTs and 6 QEDs) met our inclusion criteria. Fifteen of these studies provided some valid data for meta-analysis; these studies included 10,980 families in relevant FFT and comparison groups. All included studies had high risks of bias on at least one indicator. Half of the studies had high risks of bias on baseline equivalence, support for intent-to-treat analysis, selective reporting, and conflicts of interest. Fifteen studies had incomplete reporting of outcomes and endpoints. Using the GRADE rubric, we found that the certainty of evidence for FFT was very low for all of our primary outcomes. Using pairwise meta-analysis, we found no evidence of effects of FFT compared with other active treatments on any primary or secondary outcomes. Primary outcomes were: recidivism, out-of-home placement, internalising behaviour problems, external behaviour problems, self-reported delinquency, and drug or alcohol use. Secondary outcomes were: peer relations and prosocial behaviour, youth self esteem, parent symptoms and behaviour, family functioning, school attendance, and school performance. There were few studies in the pairwise meta-analysis (k < 7) and little heterogeneity of effects across studies in most of these analyses. There were few differences between effect estimates obtained in RCTs versus QEDs. More comprehensive CE models showed positive results of FFT in some domains and negative results in others, but these effects were small (standardised mean difference [SMD] <|0.20|) and not significantly different from no effect with one exception: Two studies found positive effects of FFT on youth substance abuse and two studies found null results in this domain, and the overall effect estimate for this outcome was statistically different from zero. Over all outcomes (15 studies and 293 effect sizes), small positive effects were detected (SMD = 0.19, SE = 0.09), but these were not significantly different from zero effect. Prediction intervals showed that future FFT evaluations are likely to produce a wide range of results, including moderate negative effects and strong positive results (-0.37 to 0.75).

Authors’ Conclusions

Results of 10 RCTs and five QEDs show that FFT does not produce consistent benefits or harms for youth with behavioural problems and their families. The positive or negative direction of results is inconsistent within and across studies. Most outcomes are not fully reported, the quality of available evidence is suboptimal, and the certainty of this evidence is very low. Overall estimates of effects of FFT may be inflated, due to selective reporting and publication biases.

Prevalence of body dysmorphic disorder: A systematic review and meta-analysis

Body dysmorphic disorder (BDD) is characterised by a preoccupation with a perceived defect in appearance. This preoccupation results in the completion of repetitive/time consuming behaviours to reduce distress. While the disorder results in considerable distress and impairment, the prevalence of the disorder is largely unknown, as BDD has not been examined in large epidemiological studies. The aim of the current study was to provide an estimate of BDD prevalence in a variety of settings using a meta-analytic approach using only studies that have made a diagnosis using a structured diagnostic interview. Twenty-two studies met criteria (n = 7159) and the pooled point-prevalence estimate for BDD was 11.3% across all studies with high levels of heterogeneity (I2 = 95.81). The pooled point-prevalence estimate was 20.0% in cosmetic/dermatology settings, 7.4% in mental health settings, and 6.7% in 'other' settings (including students and professional ballet dancers). The risk of bias assessment indicated questionable methodological quality in some of the included studies. While this study provides an important improvement on the existing literature there is a need to include BDD in epidemiological studies in order to have a more accurate understanding of the prevalence rate of this mental health condition in the community.

Diagnostic performance of radiomics model for preoperative risk categorization in thymic epithelial tumors: a systematic review and meta-analysis

BACKGROUND

Incidental thymus region masses during thoracic examinations are not uncommon. The clinician's decision-making for treatment largely depends on imaging findings. Due to the lack of specific indicators, it may be of great value to explore the role of radiomics in risk categorization of the thymic epithelial tumors (TETs).

METHODS

Four databases (PubMed, Web of Science, EMBASE and the Cochrane Library) were screened to identify eligible articles reporting radiomics models of diagnostic performance for risk categorization in TETs patients. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) and radiomics quality score (RQS) were used for methodological quality assessment. The pooled area under the receiver operating characteristic curve (AUC), sensitivity and specificity with their 95% confidence intervals were calculated.

RESULTS

A total of 2134 patients in 13 studies were included in this meta-analysis. The pooled AUC of 11 studies reporting high/low-risk histologic subtypes was 0.855 (95% CI, 0.817-0.893), while the pooled AUC of 4 studies differentiating stage classification was 0.826 (95% CI, 0.817-0.893). Meta-regression revealed no source of significant heterogeneity. Subgroup analysis demonstrated that the best diagnostic imaging was contrast enhanced computer tomography (CECT) with largest pooled AUC (0.873, 95% CI 0.832-0.914). Publication bias was found to be no significance by Deeks' funnel plot.

CONCLUSIONS

This present study shows promise for preoperative selection of high-risk TETs patients based on radiomics signatures with current available evidence. However, methodological quality in further studies still needs to be improved for feasibility confirmation and clinical application of radiomics-based models in predicting risk categorization of the thymic epithelial tumors.

Screening for Lipid Disorders in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

Importance

Lipid screening in childhood and adolescence can lead to early dyslipidemia diagnosis. The long-term benefits of lipid screening and subsequent treatment in this population are uncertain.

Objective

To review benefits and harms of screening and treatment of pediatric dyslipidemia due to familial hypercholesterolemia (FH) and multifactorial dyslipidemia.

Data Sources

MEDLINE and the Cochrane Central Register of Controlled Trials through May 16, 2022; literature surveillance through March 24, 2023.

Study Selection

English-language randomized clinical trials (RCTs) of lipid screening; recent, large US cohort studies reporting diagnostic yield or screen positivity; and RCTs of lipid-lowering interventions.

Data Extraction and Synthesis

Single extraction, verified by a second reviewer. Quantitative synthesis using random-effects meta-analysis.

Main Outcomes and Measures

Health outcomes, diagnostic yield, intermediate outcomes, behavioral outcomes, and harms.

Results

Forty-three studies were included (n = 491 516). No RCTs directly addressed screening effectiveness and harms. Three US studies (n = 395 465) reported prevalence of phenotypically defined FH of 0.2% to 0.4% (1:250 to 1:500). Five studies (n = 142 257) reported multifactorial dyslipidemia prevalence; the prevalence of elevated total cholesterol level (≥200 mg/dL) was 7.1% to 9.4% and of any lipid abnormality was 19.2%. Ten RCTs in children and adolescents with FH (n = 1230) demonstrated that statins were associated with an 81- to 82-mg/dL greater mean reduction in levels of total cholesterol and LDL-C compared with placebo at up to 2 years. Nonstatin-drug trials showed statistically significant lowering of lipid levels in FH populations, but few studies were available for any single drug. Observational studies suggest that statin treatment for FH starting in childhood or adolescence reduces long-term cardiovascular disease risk. Two multifactorial dyslipidemia behavioral counseling trials (n = 934) demonstrated 3- to 6-mg/dL greater reductions in total cholesterol levels compared with the control group, but findings did not persist at longest follow-up. Harms reported in the short-term drug trials were similar in the intervention and control groups.

Conclusions and Relevance

No direct evidence on the benefits or harms of pediatric lipid screening was identified. While multifactorial dyslipidemia is common, no evidence was found that treatment is effective for this condition. In contrast, FH is relatively rare; evidence shows that statins reduce lipid levels in children with FH, and observational studies suggest that such treatment has long-term benefit for this condition.

Radiomics-based machine learning models for prediction of medulloblastoma subgroups: a systematic review and meta-analysis of the diagnostic test performance

BACKGROUND

Medulloblastomas are a major cause of cancer-related mortality in the pediatric population. Four molecular groups have been identified, and these molecular groups drive risk stratification, prognostic modeling, and the development of novel treatment modalities. It has been demonstrated that radiomics-based machine learning (ML) models are effective at predicting the diagnosis, molecular class, and grades of CNS tumors.

PURPOSE

To assess radiomics-based ML models' diagnostic performance in predicting medulloblastoma subgroups and the methodological quality of the studies.

MATERIAL AND METHODS

A comprehensive literature search was performed on PubMed; the last search was conducted on 1 May 2022. Studies that predicted all four medulloblastoma subgroups in patients with histopathologically confirmed medulloblastoma and reporting area under the curve (AUC) values were included in the study. The quality assessments were conducted according to the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Checklist for Artificial Intelligence in Medical Imaging (CLAIM). A meta-analysis of radiomics-based ML studies' diagnostic performance for the preoperative evaluation of medulloblastoma subgrouping was performed.

RESULTS

Five studies were included in this meta-analysis. Regarding patient selection, two studies indicated an unclear risk of bias according to the QUADAS-2. The five studies had an average CLAIM score and compliance score of 23.2 and 0.57, respectively. The meta-analysis showed pooled AUCs of 0.88, 0.82, 0.83, and 0.88 for WNT, SHH, group 3, and group 4 for classification, respectively.

CONCLUSION

Radiomics-based ML studies have good classification performance in predicting medulloblastoma subgroups, with AUCs >0.80 in every subgroup. To be applied to clinical practice, they need methodological quality improvement and stability.

Prognostic factors for chronic post-surgical pain after lung and pleural surgery: a systematic review with meta-analysis, meta-regression and trial sequential analysis

Chronic post-surgical pain is known to be a common complication of thoracic surgery and has been associated with a lower quality of life, increased healthcare utilisation, substantial direct and indirect costs, and increased long-term use of opioids. This systematic review with meta-analysis aimed to identify and summarise the evidence of all prognostic factors for chronic post-surgical pain after lung and pleural surgery. Electronic databases were searched for retrospective and prospective observational studies as well as randomised controlled trials that included patients undergoing lung or pleural surgery and reported on prognostic factors for chronic post-surgical pain. We included 56 studies resulting in 45 identified prognostic factors, of which 16 were pooled with a meta-analysis. Prognostic factors that increased chronic post-surgical pain risk were as follows: higher postoperative pain intensity (day 1, 0-10 score), mean difference (95%CI) 1.29 (0.62-1.95), p < 0.001; pre-operative pain, odds ratio (95%CI) 2.86 (1.94-4.21), p < 0.001; and longer surgery duration (in minutes), mean difference (95%CI) 12.07 (4.99-19.16), p < 0.001. Prognostic factors that decreased chronic post-surgical pain risk were as follows: intercostal nerve block, odds ratio (95%CI) 0.76 (0.61-0.95) p = 0.018 and video-assisted thoracic surgery, 0.54 (0.43-0.66) p < 0.001. Trial sequential analysis was used to adjust for type 1 and type 2 errors of statistical analysis and confirmed adequate power for these prognostic factors. In contrast to other studies, we found that age had no significant effect on chronic post-surgical pain and there was not enough evidence to conclude on sex. Meta-regression did not reveal significant effects of any of the study covariates on the prognostic factors with a significant effect on chronic post-surgical pain. Expressed as grading of recommendations, assessment, development and evaluations criteria, the certainty of evidence was high for pre-operative pain and video-assisted thoracic surgery, moderate for intercostal nerve block and surgery duration and low for postoperative pain intensity. We thus identified actionable factors which can be addressed to attempt to reduce the risk of chronic post-surgical pain after lung surgery.

Determinants of humoral immune response to SARS-CoV-2 vaccines in solid cancer patients: A systematic review and meta-analysis

IMPORTANCE

Solid cancer patients following SARS-CoV-2 vaccination are likely to have a lower seroconversion rate than healthy adults. Seroconversion between those with and without cancer is likely to vary moderately or to be restricted to specific subgroups. Therefore, we sought to conduct a systematic review and meta-analysis to identify risk factors for diminished humoral immune responses in solid cancer patients.

METHODS

MEDLINE, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were used to search literature through May 1, 2022. Prospective or retrospective studies comparing responders with non-responders against SARS-CoV-2 spike (S) protein receptor-binding domain (RBD) following COVID-19 vaccination were included. Pooled Odds Ratios (pORs) with 95% CIs for binary variables and differences in means (with SDs) for continuous variables were calculated to determine the pooled effect estimates of risk factors for poor antibody response.

RESULTS

Fifteen studies enrolling 3593 patients were included in the analysis. Seroconversion was seen in 84% of the pooled study population. Male gender, age >65 years, and recent chemotherapy were all factors in a poor immune response. Patients under follow-up, those who received immunotherapy or targeted therapy, were more likely to be seropositive. Cancer subtypes, vaccine types, and timing of antibody testing from the 2nd dose of vaccine did not correlate with seroconversion.

CONCLUSION

Cytotoxic therapy for solid cancer may portend poor immune response following 2 doses of COVID-19 vaccines suggesting a need for booster doses in these patients. Immunotherapy and targeted therapy are likely to be associated with seropositive status, and thus can be considered as an alternative to cytotoxic agents in cases where both therapies are equally efficacious.

Pediatric post-discharge mortality in resource-poor countries: A protocol for an updated systematic review and meta-analysis

BACKGROUND

More than 50 countries, mainly in Sub-Saharan Africa and South Asia, are not on course to meet the neonatal and under-five mortality target set by the Sustainable Development Goals (SDGs) for the year 2030. One important, yet neglected, aspect of child mortality rates is deaths occurring during the post-discharge period. For children living in resource-poor countries, the rate of post-discharge mortality within the first several months after discharge is often as high as the rates observed during the initial admission period. This has generally been observed within the context of acute illness and has been closely linked to underlying conditions such as malnutrition, HIV, and anemia. These post-discharge mortality rates tend to be underreported and present a major oversight in the efforts to reduce overall child mortality. This review will explore recurrent illness following discharge through determination of rates of, and risk factors for, pediatric post-discharge mortality in resource-poor settings.

METHODS

Eligible studies will be retrieved using MEDLINE, EMBASE, and CINAHL databases. Only studies with a post-discharge observation period of more than 7 days following discharge will be eligible for inclusion. Secondary outcomes will include post-discharge mortality relative to in-hospital mortality, overall readmission rates, pooled estimates of risk factors (e.g. admission details vs discharge factors, clinical vs social factors), pooled post-discharge mortality Kaplan-Meier survival curves, and outcomes by disease subgroups (e.g. malnutrition, anemia, general admissions). A narrative description of the included studies will be synthesized to categorize commonly affected patient population categories and a random-effects meta-analysis will be conducted to quantify overall post-discharge mortality rates at the 6-month time point.

DISCUSSION

Post-discharge mortality contributes to global child mortality rates with a greater burden of deaths occurring in resource-poor settings. Literature concentrated on child mortality published over the last decade has expanded to focus on the fatal outcomes of children post-discharge and associated risk factors. The results from this systematic review will inform current policy and interventions on the epidemiological burden of post-discharge mortality and morbidity following acute illness among children living in resource-poor settings.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration ID: CRD42022350975.

A Systematic Review and Quantitative Synthesis of the Efficacy of Quaternary Ammonium Disinfestants Against Fungal Plant Pathogens

Quaternary ammonium compounds (QACs) have been used as disinfestants in plant production systems since the late 20th century. In studies on the control of fungal pathogens in agricultural and horticultural crop production systems, the efficacy of QAC disinfestants is variable, ranging from very high to ineffective. A systematic review and meta-analysis were performed to establish and understand how pathogen- and application-related factors influenced product efficacy. The meta-analysis was based on 124 studies involving 14 fungal plant pathogen genera, eight target materials, and four generations of QAC products that contained different mixtures of active ingredients. A significant (P < 0.0001) reduction in either disease intensity or propagule viability resulted following disinfestation using QAC products. Hedges' g standardized mean difference (g̅₊) across the studies was 2.16, indicating that QACs, on average, were highly effective against fungal pathogens. Heterogeneity was significant (P < 0.0001), indicating that effect sizes (g) were not representative of a common mean effect size and supported selection of a random effects model. In all, 78.5% of the observed variance consisted of variance in true effects with a high estimate of between-study variability (τ² = 2.15). For fungal genus, subgroup g̅₊ for genera Pseudonectria and Calonectria was significantly (P < 0.0038) higher than for all other genus subgroups, except Fusarium. For target materials, subgroup g̅₊ for solution, cloth, plant, and metal were significantly (P > 0.0071) higher than for inorganic material or wood. For product generation, subgroup g̅₊ for fifth-generation products was significantly (P > 0.0071) higher than for fourth-, third-, and second-generation products. Dose and time accounted for only 8 and 4%, respectively, of the true variance in effect sizes in the regression model dose, time, and dose-time (P = 0.0004). Genus accounted for 40 and 51% of the true variance in effect sizes in the regression models dose and genus (P = 0.0008) and time and genus (P = 0.0007), respectively. Target material accounted for 18 and 19% of the true variance in effect sizes in the regression models dose and target (P = 0.0001) and time and target (P = 0.0001), respectively. QAC product generation accounted for 24 and 21% of the true variance in effect sizes in the regression models dose and QAC generation (P = 0.0034) and time and QAC generation (P = 0.0189), respectively. These results show that the current recommended rates for dose and contact time are generally expected to result in effective disinfestation for commercial QAC products. However, the efficacy against fungal plant pathogens is likely to be influenced by the fungal genus and target being treated and the generation of the QAC product that is used for disinfestation.

BDNF-related mutations in major depressive disorder: a systematic review

OBJECTIVE

A better understanding of the genetic, molecular and cellular mechanisms of brain-derived neurotrophic factor (BDNF) and its association with neuroplasticity could play a pivotal role in finding future therapeutic targets for novel drugs in major depressive disorder (MDD). Because there are conflicting results regarding the exact role of BDNF polymorphisms in MDD still, we set out to systematically review the current evidence regarding BDNF-related mutations in MDD.

METHODS

We conducted a keyword-guided search of the PubMed and Embase databases, using 'BDNF' or 'brain-derived neurotrophic factor' and 'major depressive disorder' and 'single-nucleotide polymorphism'. We included all publications in line with our exclusion and inclusion criteria that focused on BDNF-related mutations in the context of MDD.

RESULTS

Our search yielded 427 records in total. After screening and application of our eligibility criteria, 71 studies were included in final analysis. According to present overall scientific data, there is a possibly major pathophysiological role for BDNF neurotrophic systems to play in MDD. However, on the one hand, the synthesis of evidence makes clear that likely no overall association of BDNF-related mutations with MDD exists. On the other hand, it can be appreciated that solidifying evidence emerged on specific significant sub-conditions and stratifications based on various demographic, clinico-phenotypical and neuromorphological variables.

CONCLUSIONS

Further research should elucidate specific BDNF-MDD associations based on demographic, clinico-phenotypical and neuromorphological variables. Furthermore, biomarker approaches, specifically combinatory ones, involving BDNF should be further investigated.

The efficacy of air polishing devices in supportive periodontal therapy: Clinical, microbiological and patient-centred outcomes. A systematic review

OBJECTIVES

The aim of this review was to compare air polishing devices with conventional periodontal therapy (hand instrumentation and/or ultrasonic debridement), in terms of their clinical, microbiological and patient-related outcomes in patients undergoing periodontal maintenance therapy.

METHODS

An online database search was performed to identify randomized controlled trials (RCTs) published between January 1987 and March 2021. Selection, data extraction and assessment risk of individual bias were conducted by two independent reviewers. The PICO method was employed to formulate the question: "In patients undergoing periodontal maintenance therapy/supportive periodontal therapy, do air polishing systems result in better clinical, microbiological and patient related outcomes than ultrasonic instrumentation or hand instrumentation?" Primary outcomes were bleeding on probing, gingival index and/or bleeding index. Secondary outcomes were probing depth, clinical attachment level, plaque index, microbiological counts and/or patient tolerance. The risk of bias was evaluated and the systematic review protocol was registered in PROSPERO.

RESULTS

The electronic search yielded 501 references of which 14 were included in this review. A meta-analysis was not performed due to great heterogeneity within the studies. Air polishing devices and conventional periodontal therapy presented identical results in the 14 studies analysed; however, air polishing devices presented better antimicrobial behaviour and better patient-related outcomes.

CONCLUSIONS

Both air polishing devices and conventional techniques demonstrated no difference in terms of clinical efficacy; however, air polishing devices seem to present improved antimicrobial results. In addition, they are also a safer, faster and more comfortable option for patients undergoing supportive periodontal therapy.

The Meta-Plot

Abstract. The meta-plot is a descriptive visual tool for meta-analysis that provides information on the primary studies in the meta-analysis and the results of the meta-analysis. More precisely, the meta-plot portrays (1) the precision and statistical power of the primary studies in the meta-analysis, (2) the estimate and confidence interval of a random-effects meta-analysis, (3) the results of a cumulative random-effects meta-analysis yielding a robustness check of the meta-analytic effect size with respect to primary studies’ precision, and (4) evidence of publication bias. After explaining the underlying logic and theory, the meta-plot is applied to two cherry-picked meta-analyses that appear to be biased and to 10 randomly selected meta-analyses from the psychological literature. We recommend accompanying any meta-analysis of common effect size measures with the meta-plot.

School-based Mental Health Interventions Targeting Depression or Anxiety: A Meta-analysis of Rigorous Randomized Controlled Trials for School-aged Children and Adolescents

Past meta-analyses in mental health interventions failed to use stringent inclusion criteria and diverse moderators, therefore, there is a need to employ more rigorous methods to provide evidence-based and updated results on this topic. This study presents an updated meta-analysis of interventions targeting anxiety or depression using more stringent inclusion criteria (e.g., baseline equivalence, no significant differential attrition) and additional moderators (e.g., sample size and program duration) than previous reviews. This meta-analysis includes 29 studies of 32 programs and 22,420 students (52% female, 79% White). Among these studies, 22 include anxiety outcomes and 24 include depression outcomes. Overall, school-based mental health interventions in grades K-12 are effective at reducing depression and anxiety (ES = 0.24, p = 0.002). Moderator analysis shows that improved outcomes for studies with anxiety outcomes, cognitive behavioral therapy, interventions delivered by clinicians, and secondary school populations. Selection modeling reveals significant publication and outcome selection bias. This meta-analysis suggests school-based mental health programs should strive to adopt cognitive behavioral therapy and deliver through clinicians at the secondary school level where possible.

Digital Biomarker-Based Interventions: Systematic Review of Systematic Reviews

BACKGROUND

The introduction of new medical technologies such as sensors has accelerated the process of collecting patient data for relevant clinical decisions, which has led to the introduction of a new technology known as digital biomarkers.

OBJECTIVE

This study aims to assess the methodological quality and quality of evidence from meta-analyses of digital biomarker-based interventions.

METHODS

This study follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline for reporting systematic reviews, including original English publications of systematic reviews reporting meta-analyses of clinical outcomes (efficacy and safety endpoints) of digital biomarker-based interventions compared with alternative interventions without digital biomarkers. Imaging or other technologies that do not measure objective physiological or behavioral data were excluded from this study. A literature search of PubMed and the Cochrane Library was conducted, limited to 2019-2020. The quality of the methodology and evidence synthesis of the meta-analyses were assessed using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), respectively. This study was funded by the National Research, Development and Innovation Fund of Hungary.

RESULTS

A total of 25 studies with 91 reported outcomes were included in the final analysis; 1 (4%), 1 (4%), and 23 (92%) studies had high, low, and critically low methodologic quality, respectively. As many as 6 clinical outcomes (7%) had high-quality evidence and 80 outcomes (88%) had moderate-quality evidence; 5 outcomes (5%) were rated with a low level of certainty, mainly due to risk of bias (85/91, 93%), inconsistency (27/91, 30%), and imprecision (27/91, 30%). There is high-quality evidence of improvements in mortality, transplant risk, cardiac arrhythmia detection, and stroke incidence with cardiac devices, albeit with low reporting quality. High-quality reviews of pedometers reported moderate-quality evidence, including effects on physical activity and BMI. No reports with high-quality evidence and high methodological quality were found.

CONCLUSIONS

Researchers in this field should consider the AMSTAR-2 criteria and GRADE to produce high-quality studies in the future. In addition, patients, clinicians, and policymakers are advised to consider the results of this study before making clinical decisions regarding digital biomarkers to be informed of the degree of certainty of the various interventions investigated in this study. The results of this study should be considered with its limitations, such as the narrow time frame.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/28204.

Effect of Fortified Formula on Growth and Nutritional Status in Young Children: A Systematic Review and Meta-Analysis

Previous reviews of the effect of young child formulas on health outcomes in infants and toddlers have been inconclusive. In this study, we undertook a contemporary synthesis of studies investigating the effects of consuming fortified milk beverages (compared to cow’s milk or unfortified comparator formula) on growth and/or nutritional status in children 1−3 years of age. Five electronic databases were searched (PubMed, Web of Science, Scopus, ProQuest, and Cochrane Library) for randomised controlled trials comparing fortified milk against control milk in young children (9−48 months), published between January 1990 and June 2022. Outcomes were growth, body composition, biochemical markers, and/or nutritional status. Mean differences (MD) were pooled using random-effects meta-analysis where there were ≥3 studies. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Nineteen articles (12 studies; n = 4795) met the inclusion criteria. Heterogeneity was substantial, likely attributable to considerable variation in study characteristics. Fortified milk was associated with increased weight gain (MD = 0.14 kg [95% CI 0.06, 021], p = 0.0003) compared with control milk. Subgroup analyses demonstrated increases in weight in lower-income countries, and in studies with intervention periods > 6 months. There were no effects of fortified milks on other anthropometric measures. Haemoglobin (MD = 3.76 g/L [95% CI 0.17, 7.34], p = 0.04) and ferritin (MD = 0.01 nmol/L [95% CI 0.00, 0.02], p = 0.02) concentrations were increased in infants consuming fortified milks. Fortified milk beverages appear to offer a safe and acceptable source of complementary nutrition as a short-term strategy for addressing nutritional deficits and may modestly promote weight gain in vulnerable populations when provided for periods > 6 months. This study was prospectively registered with PROSPERO (CRD42022339920) and funded by the Infant Nutrition Council.

Comparison of Three Common Intervertebral Disc Discectomies in the Treatment of Lumbar Disc Herniation: A Systematic Review and Meta-Analysis Based on Multiple Data

OBJECTIVE

Due to recent developments and the wide application of percutaneous transforaminal discectomy (PTED), we herein compare it with microendoscopic discectomy (MED) and traditional open surgery (OD) through surgical indicators and postoperative outcomes to evaluate the advantages and disadvantages of minimally invasive surgery PTED.

METHODS

This systematic review and meta-analysis was conducted in line with PRISMA guidelines (PROSPERO2018: CRD42018094890). We searched four English and two Chinese databases from the date of their establishment to May 2022. Randomized controlled trials and case-control studies of PTED versus MED or PTED versus OD in the treatment of lumbar disc herniation were retrieved.

RESULTS

A total of 33 studies with 6467 cases were included. When comparing MED with PTED, the latter had less intraoperative blood loss, smaller incision, shorter postoperative bed times, shorter hospitalization times, better postoperative visual analogue scale (VAS) for low back pain, and postoperative dysfunction index (Oswestry Disability Index, ODI) and higher recurrence rates and revision rates. However, operation times, postoperative VAS leg scores and complications, and successful operation rates were similar in both groups. Comparison of PTED with OD revealed in the former less intraoperative blood loss and smaller incision, shorter postoperative bed times, shorter hospitalization times, shorter operation times, and higher recurrence rates and revision rates. Nonetheless, comprehensive postoperative VAS scores, VAS leg pain scores, VAS low back pain, ODI and incidence of complications, and successful operation rates were similar between the two groups.

CONCLUSIONS

The therapeutic effect and safety of PTED, MED and OD in the treatment of lumbar disc herniation were comparable. PTED had obvious advantages in that it is minimally invasive, with rapid recovery after surgery, but its recurrence rates and revision rates were higher than MED and OD. Therefore, it is not possible to blindly consider replacing MED and OD with PTED.

Is hospitalization a risk factor for cognitive decline in older age adults?

OBJECTIVES

Many studies document cognitive decline following specific types of acute illness hospitalizations (AIH) such as surgery, critical care, or those complicated by delirium. However, cognitive decline may be a complication following all types of AIH. This systematic review will summarize longitudinal observational studies documenting cognitive changes following AIH in the majority admitted population and conduct meta-analysis (MA) to assess the quantitative effect of AIH on post-hospitalization cognitive decline (PHCD).

METHODS

We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria were defined to identify studies of older age adults exposed to AIH with cognitive measures. 6566 titles were screened. 46 reports were reviewed qualitatively, of which seven contributed data to the MA. Risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

The qualitative review suggested increased cognitive decline following AIH, but several reports were particularly vulnerable to bias. Domain-specific outcomes following AIH included declines in memory and processing speed. Increasing age and the severity of illness were the most consistent risk factors for PHCD. PHCD was supported by MA of seven eligible studies with 41,453 participants (Cohen's d = -0.25, 95% CI [-0.02, -0.49] I2 35%).

CONCLUSIONS

There is preliminary evidence that AIH exposure accelerates or triggers cognitive decline in the elderly patient. PHCD reported in specific contexts could be subsets of a larger phenomenon and caused by overlapping mechanisms. Future research must clarify the trajectory, clinical significance, and etiology of PHCD: a priority in the face of an aging population with increasing rates of both cognitive impairment and hospitalization.

A meta-analysis on the heritability of vertebrate telomere length

Telomere dynamics are linked with both cellular and organismal senescence, and life history, individual quality and health. Telomere dynamics, particularly telomere length, have therefore garnered much research interest in evolutionary biology. To examine the evolution of telomere length, it is important to quantify its heritability, the proportion of total variation explained by additive genetic effects. Many studies have quantified telomere length heritability, but estimates are varied, and no general conclusion has been drawn. Additionally, it is unclear whether biological and methodological factors influence telomere length heritability estimates. We present the first meta-analysis of telomere length heritability, using 104 estimates from 43 studies over 18 vertebrate species. We calculated an overall mean heritability and examined how estimates varied by study, phylogeny, species-specific ecology, environmental setting, age at sampling, laboratory methods, statistical methods, sex and repeated measurements. Overall heritability was moderate (44.9%, 95% CI: 25.2-64.7%), and there was considerable heterogeneity in heritability estimates, in particular among studies and estimates. Laboratory method influenced heritability estimates, with in-gel hybridization TRF yielding higher heritabilities than qPCR and Southern blot TRF. There was also an effect from statistical method, with twin-based and SNP-based estimates lower than correlation-based or pedigree-based estimates. Our results highlight an overall heritable basis of telomere length, and we recommend future research on a wider range of taxa, and the use of variance-partitioning methods with relatedness or SNP data over correlation methods to minimize heritability estimation bias.

Red and processed meat intakes and cardiovascular disease and type 2 diabetes mellitus: An umbrella systematic review and assessment of causal relations using Bradford Hill's criteria

Observational research suggests higher red and processed meat intakes predict greater risks of developing or dying from cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM), but this research limits causal inference. This systematic review of reviews utilizes both observational and experimental research findings to infer causality of these relations. Reviews from four databases were screened by two researchers. Reviews included unprocessed red meat (URM), processed meat (PM), or mixed URM + PM intake, and reported CVD or T2DM outcomes. Twenty-nine reviews were included, and causality was inferred using Bradford Hill's Criteria. Observational assessments of CVD outcomes and all meat types consistently reported weak associations while, T2DM outcomes and PM and Mixed URM + PM assessments consistently reported strong associations. Experimental assessments of Mixed URM + PM on CVD and T2DM risk factors were predominately not significant which lacked coherence with observational findings. For all meat types and outcomes, temporality and plausible mechanisms were established, but specificity and analogous relationships do not support causality. Evidence was insufficient for URM and T2DM. More experimental research is needed to strengthen these inferences. These results suggest that red and processed meat intakes are not likely causally related to CVD but there is potential for a causal relationship with T2DM.

Low-Dose Whole Lung Irradiation for Treatment of COVID-19 Pneumonia: A Systematic Review and Meta-Analysis

PURPOSE

Studies dating back to a century ago have reported using low-dose radiation therapy for the treatment of viral and bacterial pneumonia. In the modern era, since the COVID-19 pandemic began, several groups worldwide have researched the applicability of whole lung irradiation (WLI) for the treatment of COVID-19. We aimed to bring together the results of these experimental studies.

METHODS AND MATERIALS

We performed a systematic review and meta-analysis searching PubMed and Scopus databases for clinical trials incorporating WLI for the treatment of patients with COVID-19. Required data were extracted from each study. Using the random-effects model, the overall pooled day 28 survival rate, survival hazard ratio, and intubation-free days within 15 days after WLI were calculated, and forest plots were produced.

RESULTS

Ten studies were identified, and eventually, 5 were included for meta-analysis. The overall survival hazard ratio was calculated to be 0.85 (0.46-1.57). The pooled mean difference of intubation-free days within 15 days after WLI was 1.87, favoring the WLI group (95% confidence interval, -0.02 to 3.76). The overall day 28 survival rate of patients receiving WLI for the 9 studies with adequate follow-up data was 74% (95% confidence interval, 61-87). Except for 2 studies, the other 8 studies were assessed to have moderate to high risk of bias, and there were many differences among the designs of the studies, included patients, primary endpoints, outcome measurement methods, and reporting of the results.

CONCLUSIONS

Despite a mild improvement in intubation-free days, WLI had no significant effect on patients' overall survival. Currently, we cannot recommend routine use of WLI for the treatment of patients with moderate-to-severe COVID-19.

Deep learning for prediction of isocitrate dehydrogenase mutation in gliomas: a critical approach, systematic review and meta-analysis of the diagnostic test performance using a Bayesian approach

Background

Conventionally, identifying isocitrate dehydrogenase (IDH) mutation in gliomas is based on histopathological analysis of tissue specimens acquired via stereotactic biopsy or definitive resection. Accurate pre-treatment prediction of IDH mutation status using magnetic resonance imaging (MRI) can guide clinical decision-making. We aim to evaluate the diagnostic performance of deep learning (DL) to determine IDH mutation status in gliomas.

Methods

A systematic search of Cochrane Library, Web of Science, Medline, and Scopus was conducted to identify relevant publications until August 1, 2021. Articles were included if all the following criteria were met: (I) patients with histopathologically confirmed World Health Organization (WHO) grade II, III, or IV gliomas; (II) histopathological examination with the IDH mutation; (III) DL was used to predict the IDH mutation status; (IV) sufficient data for reconstruction of confusion matrices in terms of the diagnostic performance of the DL algorithms; and (V) original research articles. Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and Checklist for Artificial Intelligence in Medical Imaging (CLAIM) was used to assess the studies' quality. Bayes theorem was utilized to calculate the posttest probability.

Results

Four studies with a total of 1,295 patients were included. In the training set, the pooled sensitivity, specificity, and area under the summary receiver operating characteristic (SROC) curve were 93.9%, 90.9% and 0.958, respectively. In the validation set, the pooled sensitivity, specificity, and area under the SROC curve were 90.8%, 85.5% and 0.939, respectively. With a known pretest probability of 80.2%, the Bayes theorem yielded a posttest probability of 97.6% and 96.0% for a positive test and 27.0% and 30.6% for a negative test for training sets and validation sets, respectively.

Discussion

This is the first meta-analysis that summarizes the diagnostic performance of DL in predicting IDH mutation status in gliomas via the Bayes theorem. DL algorithms demonstrate excellent diagnostic performance in predicting IDH mutation in gliomas. Radiomic features associated with IDH mutation, and its underlying pathophysiology extracted from advanced MRI may improve prediction probability. However, more studies are required to optimize and increase its reliability. Limitations include obtaining some data via email and lack of training and test sets statistics.

The Campbell Collaboration's systematic review of school-based anti-bullying interventions does not meet mandatory methodological standards

BACKGROUND

Many published reviews do not meet the widely accepted PRISMA standards for systematic reviews and meta-analysis. Campbell Collaboration and Cochrane reviews are expected to meet even more rigorous standards, but their adherence to these standards is uneven. For example, a newly updated Campbell systematic review of school-based anti-bullying interventions does not appear to meet many of the Campbell Collaboration's mandatory methodological standards.

ISSUES

In this commentary, we document methodological problems in the Campbell Collaboration's new school-based anti-bullying interventions review, including (1) unexplained deviations from the protocol; (2) inadequate documentation of search strategies; (3) inconsistent reports on the number of included studies; (4) undocumented risk of bias ratings; (5) assessments of selective outcome reporting bias that are not transparent, not replicable, and appear to systematically underestimate risk of bias; (6) unreliable assessments of risk of publication bias; (7) use of a composite scale that conflates distinct risks of bias; and (8) failure to consider issues related to the strength of the evidence and risks of bias in interpreting results and drawing conclusions. Readers who are unaware of these problems may place more confidence in this review than is warranted. Campbell Collaboration editors declined to publish our comments and declined to issue a public statement of concern about this review.

CONCLUSIONS

Systematic reviews are expected to use transparent methods and follow relevant methodological standards. Readers should be concerned when these expectations are not met, because transparency and rigor enhance the trustworthiness of results and conclusions. In the tradition of Donald T. Campbell, there is need for more public debate about the methods and conclusions of systematic reviews, and greater clarity regarding applications of (and adherence to) published standards for systematic reviews.