ObjectivesTo systematically review the efficacy and safety of oral drugs for treating women with uncomplicated lower urinary tract infection.MethodsPubMed, The Cochrane Library, EMbase, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of oral drugs for treating females with uncomplicated lower urinary tract infection from inception to November, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, network meta-analysis was performed by using " gemtc” packages in R 3.5.1 software.ResultsA total of 38 RCTs were included. The results of network meta-analysis showed that: quinolones (RR=1.24, 95%CI 1.11 to 1.37), furantoin (RR=1.21, 95%CI 1.06 to 1.37), trimethoprim-sulfamethoxazole (TMP-SMZ) (RR=1.20, 95%CI 1.06 to 1.35), fosfomycin (RR=1.17, 95%CI 1.04 to 1.31) and penicillin (RR=1.18, 95%CI 1.05 to 1.33) were superior to non-steroidal anti-inflammatory drugs (NSAIDS) in clinical cure. Quinolones were better than fosfomycin (RR=1.07, 95%CI 1.03 to 1.12), penicillin (RR=1.18, 95%CI 1.13 to 1.23) and cephalosporin (RR=1.13, 95%CI 1.08 to 1.19); furantoin was better than penicillin (RR=1.15, 95%CI 1.08 to 1.21) and cephalosporin (RR=1.10, 95%CI 1.04 to 1.17); TMP-SMZ was better than penicillin (RR=1.15, 95%CI 1.09 to 1.21) and cephalosporin (RR=1.11, 95%CI 1.04 to 1.16); fosfomycin was better than penicillin (RR=1.10, 95%CI 1.04 to 1.16) in bacteriological cure. The adverse effect rates of quinolones were lower than furantoin (RR=0.83, 95%CI 0.70 to 0.98), TMP-SMZ (RR=0.88, 95%CI 0.78 to 0.99) and fosfomycin (RR=0.74, 95%CI 0.59 to 0.93), and which of fosfomycin was higher than penicillin (RR=1.33, 95%CI 1.01 to 1.74) and NSAIDS (RR=1.46, 95%CI 1.11 to 1.92). All differences were statistically significant.ConclusionsCurrent evidence shows that uncomplicated lower urinary tract infection should be recommended to therapy containing quinolones. Due to limited quality and quantity of included studies, more high-quality studies are required to verify the above conclusion.
ObjectiveTo systematically review the efficacy of exercise therapy for patients with chronic low back pain (CLBP) by network meta-analysis (NMA).MethodsThe PubMed, EBSCO, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCT) on exercise for patients with CLBP from inception to May, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, NMA was performed by Stata 15.1 software.ResultsA total of 79 RCTs involving 5 782 CLBP patients were included. The effect of exercise therapy on pain in patients with CLBP were in the following rankings: yoga (SMD=?1.25, 95%CI ?1.87 to ?0.64, P<0.000 1), health Qigong/Taichi (SMD=?1.12, 95%CI ?1.87 to ?0.64, P=0.002), sling exercise (SMD=?1.07, 95%CI ?1.64 to ?0.50, P<0.000 1), Mackenzie therapy (SMD=?1.05, 95%CI ?1.68 to ?0.42, P=0.001), pilates (SMD=?0.96, 95%CI ?1.74 to ?1.78, P=0.016), multimodal training (SMD=?0.80, 95%CI ?1.33 to ?0.27, P=0.003) and stabilisation/motor control (SMD=?0.62, 95%CI ?1.03 to ?0.21, P=0.003). The effect of exercise therapy on function in patients with CLBP were in the following rankings: Mackenzie therapy (SMD=?0.62, 95%CI ?1.03 to ?0.21, P=0.003), and yoga (SMD=?0.88, 95%CI ?1.51 to ?0.25, P=0.007). Clusterank results showed that Mackenzie therapy, yoga, pilates, sling exercise and multimodal training were similar in improving pain and physical function in patients with CLBP.ConclusionsThe current study shows that yoga, Mackenzie therapy, pilates, sling exercise and multimodal training constitute the optimal group for improving CLBP symptoms. Health Qigong/Taichi is second only to yoga in improving pain in patients with CLBP, which has great promotional value.
ObjectiveTo select the key questions of the reporting quality of acupuncture therapy network meta-analysis. MethodsA question pool about reporting quality of acupuncture therapy network meta-analysis was conducted by preliminary literature research and qualitative systematic review. A correspondence questionnaire was designed and the selection of key questions was carried out through two rounds of expert consultation using the Delphi method. ResultsA total of 21 key questions were selected for the network meta-analysis report standard of acupuncture, including whether to report details of acupuncture interventions (e.g., needle type, acupoints used, number of needles inserted, depth of needle insertion, retention time, needling techniques, and treatment duration), diagnostic criteria for diseases or traditional Chinese medicine syndromes, and qualifications of acupuncture practitioners. Of these, the only three key questions answered by the preferred reporting items for systematic reviews and network meta-analysis (PRISMA-NMA) were summary, protocol and registration, and source of funding, while the remaining 19 were specific to acupuncture-related report standards. ConclusionThe conducted key question on reporting guideline of acupuncture network meta-analysis can improve the standardization and rigor of relevant research and better utilize its academic and clinical value.
R Software is an open, free of use and charge statistical software which has a powerful graphic capability; however, it requires more complex codes and commands to perform network meta-analysis, which causes errors and difficulties in operation. WinBUGS software is based on Bayesian theory, which has a powerful data processing capability, and especially its codes are simple and easy to operate for dealing with network meta-analysis. However, its function of illustrating statistical results is very poor. In order to fully integrate the advantages of R software and WinBUGS software, an R2WinBUGS package based on R software has been developed which builds a “bridge” across two of them, making network meta-analysis process conveniently, quickly and result illustration more beautiful. In this article, we introduced how to use the R2WinBUGS package for performing network meta-analysis using examples.
With the rapidly growing literature across the surgical disciplines, there is a corresponding need to critically appraise and summarize the currently available evidence so they can be applied appropriately to patient care. The interpretation of systematic reviews is particularly challenging in cases where few robust clinical trials have been performed to address a particular question. However, risk of bias can be minimized and potentially useful conclusions can be drawn if strict review methodology is adhered to, including an exhaustive literature search, quality appraisal of primary studies, appropriate statistical methodology, assessment of confidence in estimates and risk of bias. Therefore, the following article aims to: (Ⅰ) summarize to the important features of a thorough and rigorous systematic review or meta-analysis for the surgical literature; (Ⅱ) highlight several underused statistical approaches which may yield further interesting insights compared to conventional pair-wise data synthesis techniques; and (Ⅲ) propose a guide for thorough analysis and presentation of results.
The theoretical foundation of relevant packages of R software for network meta-analysis is mainly based on Bayesian statistical model and a few of them use generalized linear model. Network meta-analysis is performed using GeMTC R package through calling the corresponding rjags package, BRugs package, or R2WinBUGS package (namely, JAGS, OpenBUGS, and WinBUGS software, respectively). Meanwhile, GeMTC R package can generate data storage files for GeMTC software. Techonically, network meta-analysis is performed through calling the software based on Markov Chain Monte Carlo method. In this article, we briefly introduce how to use GeMTC R package to perform network meta-analysis through calling the OpenBUGS software.
Objective To systematically review the efficacy of six cognitive interventions on cognitive function of patients with mild cognitive impairment after stroke. Methods The PubMed, EMbase, Cochrane Library, SinoMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials on the effects of non-drug interventions on the cognitive function of patients with mild cognitive impairment after stroke from inception to March 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Openbugs 3.2.3 and Stata 16.0 software. Results A total of 72 studies involving 4 962 patients were included. The results of network meta-analysis showed that the following five cognitive interventions improved the cognitive function of stroke patients with mild cognitive impairment: cognitive control intervention (SMD=?1.28, 95%CI ?1.686 to ?0.90, P<0.05) had the most significant effect on the improvement of cognitive function, followed by computer cognitive training (SMD=?1.02, 95%CI ?1.51 to ?0.53, P<0.05), virtual reality cognitive training (SMD=?1.20, 95%CI ?1.78 to ?0.62, P<0.05), non-invasive neural regulation (SMD=?1.09, 95%CI ?1.58 to ?0.60, P<0.05), and cognitive stimulation (SMD=?0.94, 95%CI ?1.82 to ?0.07, P<0.05). Conclusion Five cognitive interventions are effective in improving cognitive function for stroke patients with mild cognitive impairment, among which cognitive control intervention is the most effective. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Stata is statistical software that combines programming and un-programming, which is easy to operate, of high efficiency and good expansibility. In performing meta-analysis, Stata software also presents powerful function. The mvmeta package of Stata software is based on a multiple regression model to conduct network meta-analysis, and it also processes "multiple outcomes-multivariate" data. Currently, the disadvantages of mvmeta package include relatively cumbersome process, poor interest-risk sorting, and lack of drawing function in the process of conducting network meta-analysis. In this article, we introduce how to implement network meta-analysis using this package based on cases.
ObjectiveTo systematically review the diagnostic value of common screening questionnaires for chronic obstructive pulmonary disease (COPD). MethodsThe Cochrane Library, Web of Science, PubMed, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to collect diagnostic studies on the effectiveness of COPD screening questionnaires from inception to January 31 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies,then network meta-analysis was performed by using Meta-disc 1.4 and Stata 15.0 software. ResultsA total of 28 studies involving 4 screening questionnaires were included. The results of the network meta-analysis showed that, sensitivity sorting was CDQ17 > LFQ > COPD-PS4 > CDQ20 > COPD-SQ > COPD-PS5, the specificity sorting was COPD-SQ > COPD-PS5 > CDQ20 > CDQ17 > COPD-PS4 > LFQ. Subgroup analysis showed the sensitivity of CDQ17 and specificity of CDQ20 were the highest in China, the sensitivity of LFQ and specificity of COPD-PS5 were the highest in foreign countries. ConclusionCurrent evidence suggests that CDQ and LFQ have high sensitivity but poor specificity, while COPD-SQ and COPD-PS have strong specificity but poor sensitivity. In China, CDQ is recommended for screening of COPD patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective
To assess the effectiveness of acupunctures in treatment of primary dysmenorrhea by using network meta-analysis.
Methods
Databases including the PubMed, EMbase, The Cochrane Library (Issue 6, 2016), CBM, CNKI and WanFang Data were searched for relevant clinical randomized controlled trials (RCTs) comparing acupunctures with ibuprofen or other kinds of acupuncture from inception to July 6th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed by using Stata 13.0 and WinBugs 1.43 software.
Results
A total of 56 RCTs involving 4 600 PD patients were included. The results of network meta-analysis showed that: for the clinical effects: simple acupuncture, acupuncture plus moxa-moxibustion, acupuncture plus indirect-moxibustion, electroacupuncture, warm-acupuncture and electroacupuncture plus warm-acupuncture were superior to ibuprofen, acupuncture plus moxa-moxibustion, acupuncture plus indirect-moxibustion and warm-acupuncture were superior to simple acupuncture. For VAS score, there was no significant difference among all treatments. Simple acupuncture and ibuprofen were superior to acupuncture plus indirect-moxibustion in dysmenorrhea symptom scores.
Conclusion
The included 6 kinds of acupunctures are superior to ibuprofen and different acupunctures have different advantages in the treatment of PD. When selecting treatment regimen, it is better to consider the clinical situation and TCM syndrome differentiation.
