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Lopez P, Rech A, Petropoulou M, Newton RU, Taaffe DR, Galvão DA, Turella DJP, Freitas SR, Radaelli R. Does High-Velocity Resistance Exercise Elicit Greater Physical Function Benefits Than Traditional Resistance Exercise in Older Adults? A Systematic Review and Network Meta-Analysis of 79 Trials. J Gerontol A Biol Sci Med Sci 2023; 78:1471-1482. [PMID: 36378500 PMCID: PMC10395570 DOI: 10.1093/gerona/glac230] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND A systematic review and network meta-analysis was undertaken to examine the effectiveness of different modes of resistance exercise velocity in fast walking speed, timed-up and go, 5-times sit-to-stand, 30-second sit-to-stand, and 6-minute walking tests in older adults. METHODS CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus, and Web of Science databases were searched up to February 2022. Eligible randomized trials examined the effects of supervised high-velocity or traditional resistance exercise in older adults (ie, ≥60 years). The primary outcome for this review was physical function measured by fast walking speed, timed-up and go, 5-times sit-to-stand, 30-second sit-to-stand, and 6-minute walking tests, while maximal muscle power and muscle strength were secondary. A random-effects network meta-analysis was undertaken to examine the effects of different resistance exercise interventions. RESULTS Eighty articles describing 79 trials (n = 3 575) were included. High-velocity resistance exercise was the most effective for improving fast walking speed (standardized mean difference [SMD] -0.44, 95% confidence interval [CI]: 0.00 to 0.87), timed-up and go (SMD -0.76, 95% CI: -1.05 to -0.47), and 5-times sit-to-stand (SMD -0.74, 95% CI: -1.20 to -0.27), while traditional resistance exercise was the most effective for 30-second sit-to-stand (SMD 1.01, 95% CI: 0.68 to 1.34) and 6-minute walking (SMD 0.68, 95% CI: 0.34 to 1.03). CONCLUSION Our study provides evidence that resistance exercise velocity effects are specific in older adults, as evidenced by physical function test dependence. We suggest that prescriptions based on the velocity of contraction should be individualized to address the specific functional needs of participants.
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Affiliation(s)
- Pedro Lopez
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Anderson Rech
- Curso de Educação Física, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Douglas J P Turella
- Curso de Educação Física, Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Sandro R Freitas
- Neuromuscular Research Lab, Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada Dafundo, Portugal
| | - Régis Radaelli
- Neuromuscular Research Lab, Faculty of Human Kinetics, University of Lisbon, Cruz Quebrada Dafundo, Portugal
- CIPER, Faculty of Human Kinetics, University of Lisboa, Cruz Quebrada, Dafundo, Portugal
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Petropoulou M, Rücker G, Weibel S, Kranke P, Schwarzer G. Model selection for component network meta-analysis in connected and disconnected networks: a simulation study. BMC Med Res Methodol 2023; 23:140. [PMID: 37316775 DOI: 10.1186/s12874-023-01959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/29/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Network meta-analysis (NMA) allows estimating and ranking the effects of several interventions for a clinical condition. Component network meta-analysis (CNMA) is an extension of NMA which considers the individual components of multicomponent interventions. CNMA allows to "reconnect" a disconnected network with common components in subnetworks. An additive CNMA assumes that component effects are additive. This assumption can be relaxed by including interaction terms in the CNMA. METHODS We evaluate a forward model selection strategy for component network meta-analysis to relax the additivity assumption that can be used in connected or disconnected networks. In addition, we describe a procedure to create disconnected networks in order to evaluate the properties of the model selection in connected and disconnected networks. We apply the methods to simulated data and a Cochrane review on interventions for postoperative nausea and vomiting in adults after general anaesthesia. Model performance is compared using average mean squared errors and coverage probabilities. RESULTS CNMA models provide good performance for connected networks and can be an alternative to standard NMA if additivity holds. For disconnected networks, we recommend to use additive CNMA only if strong clinical arguments for additivity exist. CONCLUSIONS CNMA methods are feasible for connected networks but questionable for disconnected networks.
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Affiliation(s)
- Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany
| | - Stephanie Weibel
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Peter Kranke
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Straße 26, 79104, Freiburg, Germany.
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Kiesswetter E, Stadelmaier J, Petropoulou M, Morze J, Grummich K, Roux I, Lay R, Himmelsbach L, Kussmann M, Roeger C, Rubach M, Hauner H, Schwingshackl L. Effects of dairy intake on markers of cardio-metabolic health in adults - a systematic review with network meta-analysis. Adv Nutr 2023; 14:438-450. [PMID: 36914032 DOI: 10.1016/j.advnut.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/13/2023] Open
Abstract
Health effects of dairy products are still a matter of scientific debate due to inconsistent findings across trials. Therefore, this systematic review and network meta-analysis (NMA) aimed to compare the effects of different dairy products on markers of cardio-metabolic health. A systematic search was conducted in three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science, search date: 23/09/2022). Randomized controlled trials (RCTs) were included with ≥12 week intervention comparing any two of the eligible interventions (e.g., high dairy [≥3 servings/day or equal amount in g/day], full-fat dairy, low-fat dairy, naturally fermented milk products, low dairy/control [0-2 servings/day or usual diet]). We performed pairwise meta-analysis and NMA using random-effects model in the frequentist framework for ten outcomes (body weight, BMI, fat mass, waist circumference, LDL-cholesterol, HDL-cholesterol, triglycerides, fasting glucose, glycosylated hemoglobin, systolic blood pressure). Continuous outcome data were pooled using mean difference (MD) and dairy interventions were ranked using the surface under the cumulative ranking curve (SUCRA). Nineteen RCTs with 1427 participants were included. High dairy intake (irrespective of fat content) showed no detrimental effects on anthropometric outcomes, blood lipids, and blood pressure. Both low-fat and full-fat dairy improved systolic blood pressure (MD: -5.22 to -7.60 mmHg; low certainty), but, concomitantly, may impair glycemic control (fasting glucose [MD: 0.31 to 0.43 mmol/L] and glycosylated hemoglobin [MD: 0.37 to 0.47%]). Full-fat dairy may increase HDL-cholesterol compared to a control diet (MD: 0.26 mmol/L, 95% confidence interval (CI): 0.03, 0.49). Yogurt improved waist circumference (MD: -3.47 cm, 95%CI: -6.92, -0.02; low certainty), triglycerides (-0.38 mmol/L, 95%CI: -0.73, -0.03; low certainty), and HDL-cholesterol (MD: 0.19 mmol/L, 95%CI: 0.00, 0.38) compared to milk. In conclusion, our findings indicate that there is little robust evidence that a higher dairy intake has detrimental effects on markers of cardio-metabolic health. (PROSPERO: CRD42022303198).
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Affiliation(s)
- Eva Kiesswetter
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jakub Morze
- Department of Epidemiology and Health Promotion, School of Public Health, Center of Postgraduate Medical Education, Warsaw, Poland; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Kathrin Grummich
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Isabelle Roux
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roberta Lay
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lisa Himmelsbach
- Competence Center for Nutrition, Bavarian State Ministry for Food, Agriculture and Forestry, Freising, Germany
| | - Martin Kussmann
- Competence Center for Nutrition, Bavarian State Ministry for Food, Agriculture and Forestry, Freising, Germany
| | - Christine Roeger
- Competence Center for Nutrition, Bavarian State Ministry for Food, Agriculture and Forestry, Freising, Germany
| | - Malte Rubach
- Competence Center for Nutrition, Bavarian State Ministry for Food, Agriculture and Forestry, Freising, Germany
| | - Hans Hauner
- Else Kröner-Fresenius-Center for Nutritional Medicine, ZIEL-Institute for Food and Health, Technical University of Munich, Freising, Germany; Institute of Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Stadelmaier J, Roux I, Petropoulou M, Schwingshackl L. Empirical evidence of study design biases in nutrition randomised controlled trials: a meta-epidemiological study. BMC Med 2022; 20:330. [PMID: 36217133 PMCID: PMC9552513 DOI: 10.1186/s12916-022-02540-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Instruments to critically appraise randomised controlled trials (RCTs) are based on evidence from meta-epidemiological studies. We aim to conduct a meta-epidemiological study on the average bias associated with reported methodological trial characteristics such as random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and compliance of RCTs in nutrition research. METHODS We searched the Cochrane Database of Systematic Reviews, for systematic reviews of RCTs, published between 01 January 2010 and 31 December 2019. We combined the estimates of the average bias (e.g. ratio of risk ratios [RRR] or differences in standardised mean differences) in meta-analyses using the random-effects model. Subgroup analyses were conducted to investigate the potential differences among the RCTs with low versus high/unclear risk of bias with respect to the different types of interventions (e.g. micronutrients, fatty acids, dietary approach), outcomes (e.g. mortality, pregnancy outcomes), and type of outcome (objective, subjective). Heterogeneity was assessed through I2 and τ2, and prediction intervals were calculated. RESULTS We included 27 Cochrane nutrition reviews with 77 meta-analyses (n = 927 RCTs). The available evidence suggests that intervention effect estimates may not be exaggerated in RCTs with high/unclear risk of bias (versus low) judgement for sequence generation (RRR 0.97, 95% CI 0.93 to 1.02; I2 = 28%; τ2 = 0.002), allocation concealment (RRR 1.00, 95% CI 0.96 to 1.04; I2 = 27%; τ2 = 0.001), blinding of participants and personnel (RRR 0.95, 95% CI 0.91 to 1.00; I2 = 23%; τ2 = 0), selective reporting (RRR 0.97, 95% CI 0.92 to 1.02; I2 = 24%; τ2 = 0), and compliance (RRR 0.95, 95% CI 0.89 to 1.02; I2 = 0%; τ2 = 0). Intervention effect estimates seemed to be exaggerated in RCTs with a high/unclear risk of bias judgement for blinding of outcome assessment (RRR 0.81, 95% CI 0.70 to 0.94; I2 = 26%; τ2 = 0.03), which was predominately driven by subjective outcomes, and incomplete outcome data (RRR 0.92, 95% CI 0.88 to 0.97; I2 = 22%; τ2 = 0.001). For continuous outcomes, no differences were observed, except for selective reporting. CONCLUSIONS On average, most characteristics of nutrition RCTs may not exaggerate intervention effect estimates, but the average bias appears to be greatest in trials of subjective outcomes. Replication of this study is suggested in this field to keep this conclusion updated.
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Affiliation(s)
- Julia Stadelmaier
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Isabelle Roux
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Bröckelmann N, Balduzzi S, Harms L, Beyerbach J, Petropoulou M, Kubiak C, Wolkewitz M, Meerpohl JJ, Schwingshackl L. Evaluating agreement between bodies of evidence from randomized controlled trials and cohort studies in medical research: a meta-epidemiological study. BMC Med 2022; 20:174. [PMID: 35538478 PMCID: PMC9092682 DOI: 10.1186/s12916-022-02369-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/06/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Randomized controlled trials (RCTs) and cohort studies are the most common study design types used to assess the treatment effects of medical interventions. To evaluate the agreement of effect estimates between bodies of evidence (BoE) from randomized controlled trials (RCTs) and cohort studies and to identify factors associated with disagreement. METHODS Systematic reviews were published in the 13 medical journals with the highest impact factor identified through a MEDLINE search. BoE-pairs from RCTs and cohort studies with the same medical research question were included. We rated the similarity of PI/ECO (Population, Intervention/Exposure, Comparison, Outcome) between BoE from RCTs and cohort studies. The agreement of effect estimates across BoE was analyzed by pooling ratio of ratios (RoR) for binary outcomes and difference of mean differences for continuous outcomes. We performed subgroup analyses to explore factors associated with disagreements. RESULTS One hundred twenty-nine BoE pairs from 64 systematic reviews were included. PI/ECO-similarity degree was moderate: two BoE pairs were rated as "more or less identical"; 90 were rated as "similar but not identical" and 37 as only "broadly similar". For binary outcomes, the pooled RoR was 1.04 (95% CI 0.97-1.11) with considerable statistical heterogeneity. For continuous outcomes, differences were small. In subgroup analyses, degree of PI/ECO-similarity, type of intervention, and type of outcome, the pooled RoR indicated that on average, differences between both BoE were small. Subgroup analysis by degree of PI/ECO-similarity revealed high statistical heterogeneity and wide prediction intervals across PI/ECO-dissimilar BoE pairs. CONCLUSIONS On average, the pooled effect estimates between RCTs and cohort studies did not differ. Statistical heterogeneity and wide prediction intervals were mainly driven by PI/ECO-dissimilarities (i.e., clinical heterogeneity) and cohort studies. The potential influence of risk of bias and certainty of the evidence on differences of effect estimates between RCTs and cohort studies needs to be explored in upcoming meta-epidemiological studies.
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Affiliation(s)
- Nils Bröckelmann
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Sara Balduzzi
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Louisa Harms
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Jessica Beyerbach
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Charlotte Kubiak
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Straße 86, 79110, Freiburg, Germany.
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Petropoulou M, Salanti G, Rücker G, Schwarzer G, Moustaki I, Mavridis D. A forward search algorithm for detecting extreme study effects in network meta-analysis. Stat Med 2021; 40:5642-5656. [PMID: 34291499 DOI: 10.1002/sim.9145] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 04/14/2021] [Accepted: 06/28/2021] [Indexed: 01/03/2023]
Abstract
In a quantitative synthesis of studies via meta-analysis, it is possible that some studies provide a markedly different relative treatment effect or have a large impact on the summary estimate and/or heterogeneity. Extreme study effects (outliers) can be detected visually with forest/funnel plots and by using statistical outlying detection methods. A forward search (FS) algorithm is a common outlying diagnostic tool recently extended to meta-analysis. FS starts by fitting the assumed model to a subset of the data which is gradually incremented by adding the remaining studies according to their closeness to the postulated data-generating model. At each step of the algorithm, parameter estimates, measures of fit (residuals, likelihood contributions), and test statistics are being monitored and their sharp changes are used as an indication for outliers. In this article, we extend the FS algorithm to network meta-analysis (NMA). In NMA, visualization of outliers is more challenging due to the multivariate nature of the data and the fact that studies contribute both directly and indirectly to the network estimates. Outliers are expected to contribute not only to heterogeneity but also to inconsistency, compromising the NMA results. The FS algorithm was applied to real and artificial networks of interventions that include outliers. We developed an R package (NMAoutlier) to allow replication and dissemination of the proposed method. We conclude that the FS algorithm is a visual diagnostic tool that helps to identify studies that are a potential source of heterogeneity and inconsistency.
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Affiliation(s)
- Maria Petropoulou
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.,Evidence Synthesis Method Team, Department of Primary Education, University of Ioannina School of Education, Ioannina, Greece
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Irini Moustaki
- Department of Statistics, London School of Economics and Political Science, London, UK
| | - Dimitris Mavridis
- Evidence Synthesis Method Team, Department of Primary Education, University of Ioannina School of Education, Ioannina, Greece.,Faculté de Médecine, Université Paris Descartes, Paris, France
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Petropoulou M, Efthimiou O, Rücker G, Schwarzer G, Furukawa TA, Pompoli A, Koek HL, Del Giovane C, Rodondi N, Mavridis D. A review of methods for addressing components of interventions in meta-analysis. PLoS One 2021; 16:e0246631. [PMID: 33556155 PMCID: PMC7870082 DOI: 10.1371/journal.pone.0246631] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 01/22/2021] [Indexed: 01/11/2023] Open
Abstract
Many healthcare interventions are complex, consisting of multiple, possibly interacting, components. Several methodological articles addressing complex interventions in the meta-analytical context have been published. We hereby provide an overview of methods used to evaluate the effects of complex interventions with meta-analytical models. We summarized the methodology, highlighted new developments, and described the benefits, drawbacks, and potential challenges of each identified method. We expect meta-analytical methods focusing on components of several multicomponent interventions to become increasingly popular due to recently developed, easy-to-use, software tools that can be used to conduct the relevant analyses. The different meta-analytical methods are illustrated through two examples comparing psychotherapies for panic disorder.
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Affiliation(s)
- Maria Petropoulou
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
- Department of Primary Education, Evidence Synthesis Methods Team, University of Ioannina, Ioannina, Greece
- * E-mail:
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Gerta Rücker
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Guido Schwarzer
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Toshi A. Furukawa
- Departments of Health Promotion and Human Behavior and Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | | | - Huiberdina L. Koek
- Department of Geriatric Medicine, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dimitris Mavridis
- Department of Primary Education, Evidence Synthesis Methods Team, University of Ioannina, Ioannina, Greece
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
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Kapetanios D, Petropoulou M, Chatzelas D, Pitoulias G, Kalogirou TE, Mitka AM, Giagtzidis IT, Papazoglou KO, Karkos CD. The Effect of Transfusion of Two Units of Fresh Frozen Plasma on the Perioperative Fibrinogen Levels and the Outcome of Patients Undergoing Elective Endovascular Repair for Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 72:498-506. [PMID: 32949740 DOI: 10.1016/j.avsg.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND We aimed to investigate whether the transfusion of 2 units of fresh frozen plasma (FFP) immediately post aneurysm exclusion has any effect on the perioperative fibrinogen levels and the outcome of patients undergoing elective endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). METHODS Consecutive infrarenal AAA patients undergoing elective EVAR with the bifurcated Endurant-II stent-graft (Medtronic) were recruited from 2 vascular units. The first unit has a routine policy of administering 2 units of FFP immediately upon aneurysm exclusion (FFP group), whereas the second unit has no such policy (control group). Serum fibrinogen levels were measured on admission and 24 hr post-EVAR and the perioperative change in fibrinogen (Δfib) was calculated (24-hr postoperative minus preoperative fibrinogen). The 2 groups were compared with regards to the perioperative fibrinogen levels (preoperative, 24-hr postoperative, and Δfib) and the outcome (endoleaks, reinterventions, major adverse cardiovascular events, death) during follow up. RESULTS A total of 70 patients (41 in the FFP group, 29 controls) were examined. There were 68 men, the mean age was 70 ± 7 years and the maximum AAA diameter was 63.3 ± 13.8 mm. During the follow up (34 ± 19 months), a total of 6 endoleaks were recorded (2 type Ia, 2 type Ib and 1 type II). Mean preoperative fibrinogen, 24-hr postoperative fibrinogen and Δfib was 391.1 ± 92.8 mg/dL, 367.7 ± 97.8 mg/dL and -23.5 ± 51.02 mg/dL, respectively. There was a trend for the fibrinogen to fall 24 hr postprocedure, but this was not statistically significant (P = 0.07). There was a weak negative association between Δfib and endoleaks (P = 0.007, r = -0.29). Compared to controls, the FFP group had a higher 24-hr postoperative fibrinogen (401.8 ± 112.9 mg/dL vs. 319.3 ± 34.9 mg/dL, P < 0.0001) and a lower Δfib (-3.00 ± 56.01 mg/dL vs. -52.48 ± 21.15 mg/dL, P < 0.0001). No significant difference was observed between the 2 groups with regards to endoleaks, reinterventions, major adverse cardiovascular events, or deaths. CONCLUSIONS Transfusion of 2 units of FFP postaneurysm exclusion prevents a significant drop in plasma fibrinogen 24 hr post-EVAR, but the impact on clinical outcome has yet to be defined.
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Affiliation(s)
- Dimitrios Kapetanios
- The Department of Vascular Surgery, Ludwig-Maximilian University Hospital, Munich, Germany; The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Maria Petropoulou
- The Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Dimitrios Chatzelas
- The Department of Vascular Unit, 2nd Department of Surgery, Medical School, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Georgios Pitoulias
- The Department of Vascular Unit, 2nd Department of Surgery, Medical School, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Thomas E Kalogirou
- The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece; The Department of Vascular Unit, 2nd Department of Surgery, Medical School, Aristotle University of Thessaloniki, "G. Gennimatas" Hospital, Thessaloniki, Greece
| | - Afroditi Maria Mitka
- The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Ioakeim T Giagtzidis
- The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Konstantinos O Papazoglou
- The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece
| | - Christos D Karkos
- The Department of Vascular Unit, 5th Department of Surgery, Medical School, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece.
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9
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Tsoufakis G, Iatrou C, Petropoulou M, Zerbala S, Vayiakou H, Polychronopoulou C, Ziroyanis P. Aspergillus Fumigatus Peritonitis in a Patient on CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686089501500223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - M. Petropoulou
- Department of Microbiology General Hospital of Athens Athens, Greece
| | | | - H.A. Vayiakou
- Department of Microbiology General Hospital of Athens Athens, Greece
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10
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Abstract
Motivated by the observation of a > 290 TeV muon neutrino by IceCube, coincident with a ~6 month-long γ-ray flare of the blazar TXS 0506+056, and an archival search which revealed 13 ± 5 further, lower-energy neutrinos in the direction of the source in 2014-2015 we discuss the likely contribution of blazars to the diffuse high-energy neutrino intensity, the implications for neutrino emission from TXS 0506+056 based on multi-wavelength observations of the source, and a multi-zone model that allows for sufficient neutrino emission so as to reconcile the multi-wavelength cascade constraints with the neutrino emission seen by IceCube in the direction of TXS 0506+056.
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11
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Abstract
In network meta‐analysis (NMA), treatments can be complex interventions, for example, some treatments may be combinations of others or of common components. In standard NMA, all existing (single or combined) treatments are different nodes in the network. However, sometimes an alternative model is of interest that utilizes the information that some treatments are combinations of common components, called component network meta‐analysis (CNMA) model. The additive CNMA model assumes that the effect of a treatment combined of two components A and B is the sum of the effects of A and B, which is easily extended to treatments composed of more than two components. This implies that in comparisons equal components cancel out. Interaction CNMA models also allow interactions between the components. Bayesian analyses have been suggested. We report an implementation of CNMA models in the frequentist R package netmeta. All parameters are estimated using weighted least squares regression. We illustrate the application of CNMA models using an NMA of treatments for depression in primary care. Moreover, we show that these models can even be applied to disconnected networks, if the composite treatments in the subnetworks contain common components.
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Affiliation(s)
- Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
| | - Maria Petropoulou
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany
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12
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Panoulas VF, Keramida K, Boleti O, Papafaklis MI, Flessas D, Petropoulou M, Nihoyannopoulos P. Association between fractional flow reserve, instantaneous wave-free ratio and dobutamine stress echocardiography in patients with stable coronary artery disease. EUROINTERVENTION 2019; 13:1959-1966. [PMID: 28966160 DOI: 10.4244/eij-d-17-00594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS The association between fractional flow reserve (FFR) and dobutamine stress echocardiography (DSE) in real-world stable angina patients is scant and controversial whereas no such comparison exists with instantaneous wave-free ratio (iFR). The current retrospective study aimed to investigate the associations among these modalities in patients with stable coronary artery disease (CAD) and intermediate coronary lesions. METHODS AND RESULTS We studied 62 consecutive stable angina patients who underwent DSE and subsequently coronary angiography with FFR (in all 62) and iFR (in 46/62 patients) assessment of intermediate single-vessel lesions between 2014 and 2015. Using receiver operating characteristic (ROC) curves we sought to identify the optimal FFR and iFR cut-off points with the highest discriminative power to predict the DSE result. The kappa coefficient was used to assess the agreement between FFR, iFR and DSE. The mean age of the study cohort was 63.5±12 years and 35 (56.5%) were males. Thirteen (21%) lesions were adjudicated as causing reversible ischaemia on DSE. Using ROC (FFR predicting DSE result), the area under the curve was 0.952 (95% CI: 0.902 to 1), whereas for iFR it was 0.743 (95% CI: 0.560 to 0.927), pAUC comparison=0.03. The optimal FFR cut-off point predicting positive DSE was 0.80. There was strong agreement between DSE and FFR (kappa 0.682, p<0.001). There was only modest agreement between iFR and DSE (kappa 0.258, p=0.068) using a cut-off value of 0.9. CONCLUSIONS In patients referred for evaluation of stable CAD, there was good agreement between DSE and FFR (87%) but less so with iFR (71.7%).
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Affiliation(s)
- Vasileios F Panoulas
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
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13
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Petropoulou M, Vasilopoulos G, Christie IM, Giannios D, Coe MJ. X-ray mapping of the stellar wind in the binary PSR J2032+4127/MT91 213. ACTA ACUST UNITED AC 2017. [DOI: 10.1093/mnrasl/slx185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M Petropoulou
- Department of Physics, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
- Department of Astrophysical Sciences, Princeton University, 4 Ivy Lane, Princeton, NJ 08544, USA
| | - G Vasilopoulos
- Max-Planck-Institut für extraterrestrische Physik, Giessenbachstraße, D-85748 Garching, Germany
| | - I M Christie
- Department of Physics, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
| | - D Giannios
- Department of Physics, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
| | - M J Coe
- Physics and Astronomy and STAG Research Centre, University of Southampton, Southampton, SO17 1BJ, UK
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14
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Petropoulou M, Mavridis D. A comparison of 20 heterogeneity variance estimators in statistical synthesis of results from studies: a simulation study. Stat Med 2017; 36:4266-4280. [PMID: 28815652 DOI: 10.1002/sim.7431] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/13/2017] [Accepted: 07/10/2017] [Indexed: 12/30/2022]
Abstract
When we synthesize research findings via meta-analysis, it is common to assume that the true underlying effect differs across studies. Total variability consists of the within-study and between-study variances (heterogeneity). There have been established measures, such as I2 , to quantify the proportion of the total variation attributed to heterogeneity. There is a plethora of estimation methods available for estimating heterogeneity. The widely used DerSimonian and Laird estimation method has been challenged, but knowledge of the overall performance of heterogeneity estimators is incomplete. We identified 20 heterogeneity estimators in the literature and evaluated their performance in terms of mean absolute estimation error, coverage probability, and length of the confidence interval for the summary effect via a simulation study. Although previous simulation studies have suggested the Paule-Mandel estimator, it has not been compared with all the available estimators. For dichotomous outcomes, estimating heterogeneity through Markov chain Monte Carlo is a good choice if an informative prior distribution for heterogeneity is employed (eg, by published Cochrane reviews). Nonparametric bootstrap and positive DerSimonian and Laird perform well for all assessment criteria for both dichotomous and continuous outcomes. Hartung-Makambi estimator can be the best choice when the heterogeneity values are close to 0.07 for dichotomous outcomes and medium heterogeneity values (0.01 , 0.05) for continuous outcomes. Hence, there are heterogeneity estimators (nonparametric bootstrap DerSimonian and Laird and positive DerSimonian and Laird) that perform better than the suggested Paule-Mandel. Maximum likelihood provides the best performance for both types of outcome in the absence of heterogeneity.
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Affiliation(s)
- Maria Petropoulou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.,Department of Primary Education, University of Ioannina School of Education, Ioannina, Greece
| | - Dimitris Mavridis
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.,Department of Primary Education, University of Ioannina School of Education, Ioannina, Greece
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15
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Zarin W, Veroniki AA, Nincic V, Vafaei A, Reynen E, Motiwala SS, Antony J, Sullivan SM, Rios P, Daly C, Ewusie J, Petropoulou M, Nikolakopoulou A, Chaimani A, Salanti G, Straus SE, Tricco AC. Erratum to: Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review. BMC Med 2017; 15:61. [PMID: 28292298 PMCID: PMC5348821 DOI: 10.1186/s12916-017-0832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Wasifa Zarin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Afshin Vafaei
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Emily Reynen
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Sanober S Motiwala
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Shannon M Sullivan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Caitlin Daly
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Joycelyne Ewusie
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Maria Petropoulou
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece
| | - Adriani Nikolakopoulou
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece
| | - Georgia Salanti
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A1, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada. .,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada.
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16
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Petropoulou M, Nikolakopoulou A, Veroniki AA, Rios P, Vafaei A, Zarin W, Giannatsi M, Sullivan S, Tricco AC, Chaimani A, Egger M, Salanti G. Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015. J Clin Epidemiol 2017; 82:20-28. [DOI: 10.1016/j.jclinepi.2016.11.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/07/2016] [Accepted: 11/09/2016] [Indexed: 01/19/2023]
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17
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Zarin W, Veroniki AA, Nincic V, Vafaei A, Reynen E, Motiwala SS, Antony J, Sullivan SM, Rios P, Daly C, Ewusie J, Petropoulou M, Nikolakopoulou A, Chaimani A, Salanti G, Straus SE, Tricco AC. Characteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review. BMC Med 2017; 15:3. [PMID: 28052774 PMCID: PMC5215202 DOI: 10.1186/s12916-016-0764-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 12/02/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Network meta-analysis (NMA) has become a popular method to compare more than two treatments. This scoping review aimed to explore the characteristics and methodological quality of knowledge synthesis approaches underlying the NMA process. We also aimed to assess the statistical methods applied using the Analysis subdomain of the ISPOR checklist. METHODS Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, and Cochrane Database of Systematic Reviews from inception until April 14, 2015. References of relevant reviews were scanned. Eligible studies compared at least four different interventions from randomised controlled trials with an appropriate NMA approach. Two reviewers independently performed study selection and data abstraction of included articles. All discrepancies between reviewers were resolved by a third reviewer. Data analysis involved quantitative (frequencies) and qualitative (content analysis) methods. Quality was evaluated using the AMSTAR tool for the conduct of knowledge synthesis and the ISPOR tool for statistical analysis. RESULTS After screening 3538 citations and 877 full-text papers, 456 NMAs were included. These were published between 1997 and 2015, with 95% published after 2006. Most were conducted in Europe (51%) or North America (31%), and approximately one-third reported public sources of funding. Overall, 84% searched two or more electronic databases, 62% searched for grey literature, 58% performed duplicate study selection and data abstraction (independently), and 62% assessed risk of bias. Seventy-eight (17%) NMAs relied on previously conducted systematic reviews to obtain studies for inclusion in their NMA. Based on the AMSTAR tool, almost half of the NMAs incorporated quality appraisal results to formulate conclusions, 36% assessed publication bias, and 16% reported the source of funding. Based on the ISPOR tool, half of the NMAs did not report if an assessment for consistency was conducted or whether they accounted for inconsistency when present. Only 13% reported heterogeneity assumptions for the random-effects model. CONCLUSIONS The knowledge synthesis methods and analytical process for NMAs are poorly reported and need improvement.
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Affiliation(s)
- Wasifa Zarin
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Afshin Vafaei
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Emily Reynen
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Sanober S Motiwala
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Shannon M Sullivan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Caitlin Daly
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Joycelyne Ewusie
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada
| | - Maria Petropoulou
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece
| | - Adriani Nikolakopoulou
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anna Chaimani
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece
| | - Georgia Salanti
- Department of Hygiene and Epidemiology, University of Ioannina, Ioannina, 45110, Greece.,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 1A1, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, M5B 1W8, Canada. .,Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M7, Canada.
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18
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Christie IM, Petropoulou M, Mimica P, Giannios D. Modelling accretion disc and stellar wind interactions: the case of Sgr A. Mon Not R Astron Soc 2016; 459:2420-2431. [PMID: 27279781 DOI: 10.1093/mnras/stw749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/27/2016] [Accepted: 03/27/2016] [Indexed: 06/06/2023]
Abstract
Sgr A* is an ideal target to study low-luminosity accreting systems. It has been recently proposed that properties of the accretion flow around Sgr A* can be probed through its interactions with the stellar wind of nearby massive stars belonging to the S-cluster. When a star intercepts the accretion disc, the ram and thermal pressures of the disc terminate the stellar wind leading to the formation of a bow shock structure. Here, a semi-analytical model is constructed which describes the geometry of the termination shock formed in the wind. With the employment of numerical hydrodynamic simulations, this model is both verified and extended to a region prone to Kelvin-Helmholtz instabilities. Because the characteristic wind and stellar velocities are in ∼108 cm s-1 range, the shocked wind may produce detectable X-rays via thermal bremsstrahlung emission. The application of this model to the pericentre passage of S2, the brightest member of the S-cluster, shows that the shocked wind produces roughly a month long X-ray flare with a peak luminosity of L ≈ 4 × 1033 erg s-1 for a stellar mass-loss rate, disc number density, and thermal pressure strength of [Formula: see text], nd = 105 cm-3, and α = 0.1, respectively. This peak luminosity is comparable to the quiescent X-ray emission detected from Sgr A* and is within the detection capabilities of current X-ray observatories. Its detection could constrain the density and thickness of the disc at a distance of ∼3000 gravitational radii from the supermassive black hole.
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Affiliation(s)
- I M Christie
- Department of Physics and Astronomy, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
| | - M Petropoulou
- Department of Physics and Astronomy, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
| | - P Mimica
- Departament d'Astronomia i Astrofísica Universitat de València, C/ Dr. Moliner, 50, E-46100 Burjassot, València, Spain
| | - D Giannios
- Department of Physics and Astronomy, Purdue University, 525 Northwestern Avenue, West Lafayette, IN 47907, USA
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Mastichiadis A, Petropoulou M, Dimitrakoudis S. Time dependent photon and neutrino emission from Mkr 421 in the context of the one-zone leptohadronic model. EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20136105005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Petropoulou M, Mastichiadis A. Time-dependent modelling of PKS 2155-304 in a low state: one- or two-zone emission modelling? EPJ Web of Conferences 2013. [DOI: 10.1051/epjconf/20136105013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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Berman AM, Kalchman GG, Chattoraj SC, Scommegna A, Petropoulou M. Relationship of amniotic fluid estriol to maternal urinary estriol. Am J Obstet Gynecol 1968; 100:15-23. [PMID: 5634430 DOI: 10.1016/s0002-9378(15)33633-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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