Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis

BackgroundPrevious reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.ObjectiveTo analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.MethodsAfter identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.ResultsWhen comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD = 0.47, 95% CI 0.27–0.67), autobiographical memory (0.67, 0.02–1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06–1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05–0.70). Moderate effects on activities of daily living (0.28; −0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; −0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22–0.89) and depression (0.64; 0.21–1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.ConclusionCognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.     

Systematic review and meta-analysis of observational studies on BD-IPMNS progression to malignancy

BackgroundThe vast majority of presumed branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas are referred to a surveillance program due to the relatively low risk of malignancy. We aim to evaluate all available data from observational studies focused on the risks of BD-IPMN progression and malignancy to provide vital insights into its management in clinical practice.MethodsA comprehensive search was conducted at PubMed, Cochrane, Web of Science and Embase for observational studies published before January 1st, 2020. The progression of BD-IPMN was defined as the development of worrisome features (WFs) or high-risk stigmata (HRS) during surveillance. Overall malignancy was defined as all malignancies, such as malignant IPMN, concomitant pancreatic ductal adenocarcinoma (PDAC) and other malignancies, including BD-IPMN with high-grade sec. Baltimore consensus 2015 or BD-IPMN with high-grade dysplasia (carcinoma in situ) sec. WHO 2010. A meta-analysis was performed to investigate the presence of a mural nodule as a possible predictor of malignancy.ResultsTwenty-four studies were included, with a total of 8941 patients with a presumed BD-IPMN. The progression rate was 20.2%, and 11.8% underwent surgery, 29.5% of whom showed malignancy at the final pathology. Of those, 78% had malignant IPMNs, and 22% had concomitant pancreatic cancer. Overall, 0.5% had distant metastasis. The meta-analysis showed that the risk of malignancy in the presence of a mural nodule >5 mm had a RR of 5.457 (95% CI 1.404–21.353), while a nonenhancing mural nodule or an enhancing mural nodule < 5 mm had a RR of 5.286 (95% CI 1.805–15.481) of harboring malignancy.ConclusionMost presumed BD-IPMNs entering surveillance do not become malignant. Of those submitted to surgery, concomitant PDAC adds to the overall risk of detecting malignancy.     

Meditation for asthma: Systematic review and meta-analysis

Objective: To conduct a comprehensive review and meta-analysis of the effectiveness of meditation on a variety of asthma outcomes. Methods: We searched MEDLINE, EMBASE, CINAHL, PsycINFO and AMED in June 2016 to identify randomized controlled trials (RCTs) investigating the effectiveness of meditation in adults with asthma. No restriction was put on language or year of publication. Study quality was assessed using The Cochrane Risk of Bias Assessment Tool. Meta-analysis was carried out using RevMan 5.3. Results: Four RCTs involving 201 patients met the inclusion criteria. Quality of studies was inconsistent with only one study reporting adequate allocation concealment. Disease-specific quality of life was assessed in two trials; a pooled result involving 62 intervention and 65 control participants indicated a significant improvement in quality of life in the meditation group compared to the control group (SMD 0.40, 95% CI 0.05–0.76). A pooled result from all four studies indicated the uncertain effect of meditation in forced expiratory volume in 1 s (FEV₁) (SMD ?0.67, 95% CI ?2.17 to 0.82). Results from the individual trials suggest that meditation may be helpful in reducing perceived stress and the use of short-term rescue medication. Conclusion: Our review suggests that there is some evidence that meditation is beneficial in improving quality of life in asthma patients. As two out of four studies in our review were of poor quality, further trials with better methodological quality are needed to support or refute this finding.     

A systematic review and meta-analysis of placebo-controlled antidepressant studies in people with depression and dementia

OBJECTIVES: To determine the efficacy of antidepressants in people with depression and dementia. DESIGN: A systematic review and meta‐analysis based on a literature search of Medline and Cochrane Trials Registry for acute‐phase, double‐blind, placebo‐controlled, parallel‐design, random‐assignment trials of antidepressants marketed in the United States. SETTING: Outpatient clinics, inpatient units, residential settings. PARTICIPANTS: People with criterion‐based diagnoses of dementia and depression. MEASUREMENTS: Numbers of participants randomized; baseline and end point depression scale scores; and response, remission, and discontinuation rates were extracted. Random‐effects meta‐analyses were performed for response and remission rates, change scores using standardized mean differences, and discontinuation rates. Sensitivity analyses were planned to examine effects of depression diagnosis, severity, and trial duration. RESULTS: Seven trials with 330 participants met selection criteria. The odds ratio (OR) for six trials reporting response rates with antidepressant and placebo was 2.12 (95% confidence interval (CI)=0.95–4.70; Z=1.84, P=.07). The OR for five trials reporting remission rates was 1.97 (95% CI=0.85–4.55; Z=1.59, P=.11). Both analyses demonstrated heterogeneity. The standardized mean difference in trials was 0.29 (95% CI=0.02–0.60, Z=1.86, P=.06). This analysis did not demonstrate significant heterogeneity. Adverse event discontinuation rates (9.0%) were not significantly higher with drug than placebo (6.0%), and were low. CONCLUSION: The evidence for antidepressant treatment of people with depression and dementia, although suggestive, does not confirm efficacy. All of the trials were significantly underpowered to detect differences, resulting in inconclusive findings. Variable trial methods, comorbid conditions, and differences in antidepressants employed further confounded findings.     

Tobacco smoking and intestinal metaplasia: Systematic review and meta-analysis

Background

The evaluation of specific risk factors for early endpoints in the gastric carcinogenesis pathway may further contribute to the understanding of gastric cancer aetiology.

Aims

To quantify the relation between smoking and intestinal metaplasia through systematic review and meta-analysis.

Methods

Articles providing data on the association between smoking and intestinal metaplasia were identified in PubMed^®, Scopus^® and Web of Science™, searched until April 2014, and through backward citation tracking. Summary odds ratio estimates and 95% confidence intervals were computed using the DerSimonian and Laird method. Heterogeneity was quantitatively assessed using the I² statistic.

Results

A total of 32 articles were included in this systematic review and 19 provided data for meta-analysis. Smoking was defined as ever vs. never (crude estimates, six studies, summary odds ratio = 1.54, 95% confidence interval: 1.12–2.12, I² = 67.4%; adjusted estimates, seven studies, summary odds ratio = 1.26, 95% confidence interval: 0.98–1.61, I² = 65.0%) and current vs. non-smokers (crude estimates, seven studies, summary odds ratio = 1.27, 95% confidence interval: 0.88–1.84, I² = 73.4%; adjusted estimates, two studies, summary odds ratio 1.49, 95% confidence interval: 0.99–2.25, I² = 0.0%).

Conclusion

The weak and non-statistically significant association found through meta-analysis of the available evidence does not confirm smoking as an independent risk factor for intestinal metaplasia.     

Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care

BackgroundEmpirical studies examined the associations between hospital competition and quality of care by using different methodology, measures, patient groups and geographic locations; however, results remained inconclusive. This study aimed to apply meta-analysis to evaluate the effect of hospital competition on quality of care and to explore the potential implications to care for senior patients.MethodsA systematic review and meta-analysis combining results from various studies to obtain an overall outcome was performed. Measure of effect size, I² test, meta-regression to find sources of heterogeneity, tests for publication bias, sensitivity analysis and cumulative analysis were performed. The mean effect size is estimated by coefficient and standard error with P values less than 0.05 which was considered statistically significant.ResultsBased on the selection criteria, only 11 studies were eligible for this meta-analysis. The pooled effect of hospital competition on quality of care was reported by all of the 11 included studies. Results of the meta-analysis suggested that hospital competition reduced quality of care, but the overall effect was relatively insignificant from a statistical perspective (Point estimate = 0.008, 95% CI = -0.004 ˜ 0.020, P > 0.05).ConclusionsHospital competition slightly increased mortality rates of acute myocardial infarction, but not statistically significant. The negative impact may be lessened over time as medical technology, practices, and techniques improve. Older patients with complex care needs may be at risk for poorer quality of care related to hospital competition.     

Heart involvement in Rheumatoid Arthritis: Systematic review and meta-analysis

Objective

The aim of our study was to conduct a systematic review with meta-analysis of the current case–control studies about the valvular and pericardial involvement in patients with Rheumatoid Arthritis (RA), asymptomatic for cardiovascular diseases.

Methods

Case–control studies were identified by searching PubMed (1975–2010) and the Cochrane Central Register of Controlled Trials (CENTRAL) (1975–2010). Participants were adult patients with RA asymptomatic for cardiovascular diseases, and the outcome measure was the presence of cardiac involvement.

Results

Quantitative synthesis included 10 relevant studies out of 2326 bibliographic citations that had been found. RA resulted significantly associated to pericardial effusion (OR 10.7; 95% CI 5.0–23.0), valvular nodules (OR 12.5; 95% CI 2.8–55.4), tricuspidal valve insufficiency (OR 5.3; 95% CI 2.4–11.6), aortic valve stenosis (OR 5.2; 95% CI 1.1–24.1), mitral valve insufficiency (OR 3.4; 95% CI 1.7–6.7), aortic valve insufficiency (OR 1.7; 95% CI 1.0–2.7), combined valvular alterations (OR 4.3; 95% CI 2.3–8.0), mitral valve thickening and/or calcification (OR 5.0; 95% CI 2.0–12.7), aortic valve thickening and/or calcification (OR 4.4; 95% CI 1.1–17.4), valvular thickening and/or calcification (OR 4.8; 95% CI 2.2–10.5), and mitral valve prolapse (OR 2.2; 95% CI 1.2–4.0).

Conclusions

Our systematic review pointed out the strength and the grade of both pericardial and cardiac valvular involvement in RA patients. Our findings underscore the importance of an echocardiographic assessment at least in clinical research when RA patients are involved. Moreover, further research is needed to understand the possible relationship of our findings and the increased cardiovascular mortality.     

Systematic review and meta-analysis of clinical trials: In–hospital use of sensors for prevention of falls

Background:Intra-hospital falls have become an important public health problem globally. The use of movement sensors with alarms has been studied as elements with predictive capacity for falls at hospital level. However, in spite of their use in some hospitals throughout the world, evidence is lacking about their effectiveness in reducing intra-hospital falls. Therefore, this study aims to develop a systematic review and meta-analysis of existing scientific literature exploring the impact of using sensors for fall prevention in hospitalized adults and the elderly population.Methods:We explored literature based on clinical trials in Spanish, English, and Portuguese, assessing the impact of devices used for hospital fall prevention in adult and elderly populations. The search included databases such as IEEE Xplore, the Cochrane Library, Scopus, PubMed, MEDLINE, and Science Direct databases. The critical appraisal was performed independently by two researchers. Methodological quality was assessed based on the ratings of individual biases. We performed the sum of the results, generating an estimation of the grouped effect (Relative Risk, 95% CI) for the outcome first fall for each patient. We assessed heterogeneity and publication bias. The study followed PRISMA guidelines.Results:Results were assessed in three randomized controlled clinical trials, including 29,691 patients. A total of 351 (3%) patients fell among 11,769 patients assigned to the intervention group, compared with 426 (2.4%) patients who fell among 17,922 patients assigned to the control group (general estimation RR 1.20, 95% CI 1.04, 1.37, P = .02, I² = 0%; Moderate GRADE).Conclusion:Our results show an increase of 19% in falls among elderly patients who are users of sensors located in their bed, bed-chair, or chair among their hospitalizations. Other types of sensors such as wearable sensors can be explored as coadjutants for fall prevention care in hospitals.     

Systematic review and meta-analysis of observational studies on the prevalence of fractures in coeliac disease

BACKGROUND/AIMS: Evidence of an increased bone fracture risk in coeliac disease is on debate. Our aim was to review systematically the current published information on fractures in coeliac disease and to perform a meta-analysis. METHODS: Case-control and cohort designs were identified by searching MEDLINE (1966-April 2007) and LILACS (1982-April 2007). Participants were adult coeliac disease patients of any sex and the outcome measure was the presence of any fracture. Studies were screened for inclusion by two authors who independently extracted the data. Methodological quality was assessed using the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology Statement) recommendations. Data were analysed using the RevMan Analyses statistical package in Review Manager (version 4.2.8) and reported as pooled odds ratio using a random effect model. Heterogeneity was investigated (standard chi(2) test) and sensitivity analysis was performed based on the reported quality and design type. RESULTS: While 60 of 405 studies met the initial screening criteria, only 8 met inclusion criteria after detailed review. These studies evaluated a total of 20,955 coeliac disease patients having 1819 (8.7%) fractures and 96,777 controls with 5955 (6.1%) fractures (pooled odds ratio=1.43; 95% confidence interval 1.15-1.78) with considerable heterogeneity among studies (p<0.00001). CONCLUSIONS: Our meta-analysis confirms a significant association between bone fractures and coeliac disease. However, qualitative and quantitative differences among studies were evident. Further research is necessary to investigate the relevance of this heterogeneity.     

Distance management of inflammatory bowel disease:Systematic review and meta-analysis

AIM:To review the effectiveness of distance management methods in the management of adult inflammatory bowel disease(IBD)patients.METHODS:A systematic review and meta-analysis of randomized controlled trials comparing distance management and standard clinic follow-up in the management of adult IBD patients.Distance management intervention was defined as any remote management method in which there is a patient self-management component whereby the patient interacts remotely via a self-guided management program,electronic interface,or self-directs open access to clinic follow up.The search strategy included electronic databases(Medline,PubMed,CINAHL,The Cochrane Central Register of Controlled Trials,EMBASE,KTPlus,Web of Science,and SCOPUS),conference proceedings,and internet search for web publications.The primary outcome was the mean difference in quality of life,and the secondary outcomes included mean difference in relapse rate,clinic visit rate,and hospital admission rate.Study selection,data extraction,and risk of bias assessment were completed by two independent reviewers.RESULTS:The search strategy identified a total of4061 articles,but only 6 randomized controlled trials met the inclusion and exclusion criteria for the systematic review and meta-analysis.Three trials involved telemanagement,and three trials involved directed patient self-management and open access clinics.The total sample size was 1463 patients.There was a trend towards improved quality of life in distance management patients with an end IBDQ quality of life score being 7.28(95%CI:-3.25-17.81)points higher than standard clinic follow-up.There was a significant decrease in the clinic visit rate among distance management patients mean difference-1.08(95%CI:-1.60--0.55),but no significant change in relapse rate or hospital admission rate.CONCLUSION:Distance management of IBD significantly decreases clinic visit utilization,but does not significantly affect relapse rates or hospital admission rates.     

Mortality and survival in systemic sclerosis: Systematic review and meta-analysis

Objective

To determine the mortality, survival, and causes of death in patients with systemic sclerosis (SSc) through a meta-analysis of the observational studies published up to 2013.

Methods

We performed a systematic review and meta-analysis of the observational studies in patients with SSc and mortality data from entire cohorts published in MEDLINE and SCOPUS up to July 2013.

Results

A total of 17 studies were included in the mortality meta-analysis from 1964 to 2005 (mid-cohort years), with data from 9239 patients. The overall SMR was 2.72 (95% CI: 1.93–3.83). A total of 43 studies have been included in the survival meta-analysis, reporting data from 13,529 patients. Cumulative survival from onset (first Raynaud?s symptom) has been estimated at 87.6% at 5 years and 74.2% at 10 years, from onset (non-Raynaud?s first symptom) 84.1% at 5 years and 75.5% at 10 years, and from diagnosis 74.9% at 5 years and 62.5% at 10 years. Pulmonary involvement represented the main cause of death.

Conclusions

SSc presents a larger mortality than general population (SMR = 2.72). Cumulative survival from diagnosis has been estimated at 74.9% at 5 years and 62.5% at 10 years. Pulmonary involvement represented the main cause of death.     

Association between clusterin concentration and dementia: a systematic review and meta-analysis

Metabolic Brain Disease - Studies have showed that high clusterin (CLU) concentration was associated with increased risk of dementia. However, the results based on small samples remained...     

Systematic review of statins for the prevention of vascular dementia or dementia

Aim: Non‐hypolipidemic effects of statins, known as pleiotropic effects, are likely to explain the effect of statins on dementia. Results of the relationship between statins and dementia in previous studies are conflicting. There is no systematic review investigating the effect of statins on vascular dementia (VaD). This systematic review evaluates the role of statins in the prevention of VaD or dementia. The possible causes of conflicting results in the existing published work will be explored. Methods: Relevant studies were systematically identified and reviewed. The Cochrane Controlled Trials and three electronic databases (MEDLINE, EMBASE and PsycInfo) were searched. The selection criteria were defined a priori. Included studies were rated by quality assessment checklists and two independent reviewers. Results: Six studies in dementia, two studies in VaD (one study reported both dementia and VaD) and two meta‐analyses met the selection criteria. The studies covered 1372 cases of dementia from 14 430 participants and 116 cases of VaD from 4924 participants from the USA and UK. There was no association between statin use and risk of VaD. The protective effect of statins on dementia was demonstrated only in a nested case–control study of lower quality and one recently published cohort study. In most other cohort and high quality studies, statin use did not show a beneficial effect. Conclusion: Study design differences among the studies and methodological shortcomings may have resulted in different outcomes. On the basis of these conflicting results, statins could not be recommended as a preventative treatment for dementia.     

Circumstance of endoscopic and laparoscopic treatments for gastric cancer in Japan: A review of epidemiological studies using a national administrative database

Currently, endoscopic submucosal dissection(ESD) and laparoscopic gastrectomy(LG) have become widely accepted and increasingly play important roles in the treatment of gastric cancer. Data from an administrative database associated with the diagnosis procedure combination(DPC) system have revealed some circumstances of ESD and LG in Japan. Some studiesdemonstrated that medical costs or length of stay of patients receiving ESD for gastric cancer had become significantly reduced while length of hospitalization and costs were significantly increased in older patients. With respect to LG, some recent reports have shown that this has been a cost-beneficial treatment for patients compared with open gastrectomy while simultaneous LG and cholecystectomy is a safe procedure for patients with both gastric cancer and gallbladder stones. These epidemiological studies using the administrative database in the DPC system closely reflect clinical circumstances of endoscopic and surgical treatment for gastric cancer in Japan. However, DPC database does not contain detailed clinical data such as histological types and lesion size of gastric cancer. The link between the DPC database and another detailed clinical database may be vital for future research into endoscopic and laparoscopic treatments for gastric cancer.     

Occupational and environmental scleroderma. Systematic review and meta-analysis

The etiology of systemic sclerosis (SSc) remains unknown; however, several occupational and environmental factors have been implicated. Our objective was to perform a meta-analysis of all studies published on SSc associated with occupational and environmental exposure. The review was undertaken by means of MEDLINE and SCOPUS from 1960 to 2014 and using the terms: “systemic,” “scleroderma,” or “systemic sclerosis/chemically induced” [MesH]. The Newcastle-Ottawa Scale was used for the qualifying assessment. The inverse variance-weighted method was performed. The meta-analysis of silica exposure included 15 case-control studies [overall OR 2.81 (95%CI 1.86–4.23; p < 0.001)] and 4 cohort studies [overall RR 17.52 (95%CI 5.98–51.37; p < 0.001)]; the meta-analysis of solvents exposure included 13 case-control studies (overall OR 2.00 [95%CI 1.32–3.02; p = 0.001); the meta-analysis of breast implants exposure included 4 case-control studies (overall OR 1.68 (95%CI 1.65–1.71; p < 0.001)) and 6 cohort studies (overall RR 2.13 (95%CI 0.86–5.27; p = 0.10)); the meta-analysis of epoxy resins exposure included 4 case-control studies (overall OR 2.97 (95%CI 2.31–3.83; p < 0.001)), the meta-analysis of pesticides exposure included 3 case-control studies (overall OR 1.02 (95%CI 0.78–1.32; p = 0.90)) and, finally, the meta-analysis of welding fumes exposure included 4 studies (overall OR 1.29 (95%CI 0.44–3.74; p = 0.64)). Not enough studies citing risks related to hair dyes have been published to perform an accurate meta-analysis. Silica and solvents were the two most likely substances related to the pathogenesis of SSc. While silica is involved in particular jobs, solvents are widespread and more people are at risk of having incidental contact with them.