Areti Angeliki (Argie) Veroniki

BackgroundSystematic reviews (SRs) are being published at an accelerated rate. Decision makers may struggle with comparing and choosing between multiple SRs on the same topic. We aimed to understand how healthcare decision makers (eg, practitioners, policymakers, researchers) use SRs to inform decision making, and to explore the role of a proposed AI tool to assist in critical appraisal and choosing amongst SRs.MethodsWe developed a survey with 21 open and closed questions. We followed a knowledge translation plan to disseminate the survey through social media and professional networks.ResultsOf the 684 respondents, 58.2% identified as researchers, 37.1% as practitioners, 19.2% as students, and 13.5% as policymakers. Respondents frequently sought out SRs (97.1%) as a source of evidence to inform decision making. They frequently (97.9%) found more than one SR on a given topic of interest to them. Just over half (50.8%) struggled to choose the most trustworthy SR amongst multiple. These difficulties related to lack of time (55.2%), or difficulties comparing due to varying methodological quality of SRs (54.2%), differences in results and conclusions (49.7%), or variation in the included studies (44.6%). Respondents compared SRs based on the relevance to their question of interest, methodological quality, recency of the SR search. Most respondents (87.0%) were interested in an AI tool to help appraise and compare SRs.ConclusionsRespondents often sought out SRs as a source of evidence in their decision making, and often encountered more than one SR on a given topic of interest. Many decision makers struggled to …

ObjectivesClinical study reports (CSRs) are highly detailed documents that play a pivotal role in medicine approval processes. Though not historically publicly available, in recent years, major entities including the European Medicines Agency (EMA), Health Canada, and the US Food and Drug Administration (FDA) have highlighted the importance of CSR accessibility. The primary objective herein was to determine the proportion of CSRs that support medicine approvals available for public download as well as the proportion eligible for independent researcher request via the study sponsor.Study Design and SettingThis cross-sectional study examined the accessibility of CSRs from industry-sponsored clinical trials whose results were reported in the FDA-authorized drug labels of the top 30 highest-revenue medicines of 2021. We determined (1) whether the CSRs were available for download from a public …

Objectives To compare the efficacy of influenza vaccines of any valency for adults 60 years and older.Design and setting Systematic review with network meta-analysis (NMA) of randomised controlled trials (RCTs). MEDLINE, EMBASE, JBI Evidence-Based Practice (EBP) Database, PsycINFO, and Cochrane Evidence -Based Medicine database were searched from inception to 20 June 20, 2022. Two reviewers screened, abstracted, and appraised articles (Cochrane Risk of Bias (ROB) 2.0 tool) independently. We assessed certainty of findings using Confidence in Network Meta-Analysis and Grading of Recommendations, Assessment, Development and Evaluations approaches. We performed random-effects meta-analysis and network meta-analysis (NMA), and estimated odds ratios (ORs) for dichotomous outcomes and incidence rate ratios (IRRs) for count outcomes along with their corresponding 95 …

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was developed to increase transparency and reproducibility of systematic reviews. PRISMA, first published in 2009, was designed for systematic reviews with pairwise meta-analyses of healthcare interventions, and has been widely used by authors and journals. There are multiple extensions to PRISMA developed to reflect diversity of research synthesis methodologies. An extension to the PRISMA 2009 statement was published in 2015 to guide reporting of systematic reviews with network meta-analysis (NMA). In 2020, the PRISMA statement was updated to reflect advances in the conduct and reporting of systematic reviews. These advances have yet to be incorporated into the PRISMA extension for NMA. Other advancements in NMA methodology also necessitate a significant update to PRISMA-NMA.

To the Editor We read the article by Bretthauer et al1 with interest. Of late, there is intense focus on the merits of cancer screening and the need to effectively deploy cancer screening programs in diverse populations. This article advances the discussion on this important and timely topic. We applaud Bretthauer et al1 for translating meta-analysis–derived relative risks of all-cause mortality associated with cancer screening into absolute effect estimates (ie, lifetime gained), which can be more readily understood by clinicians and patients when considering potential risks and benefits of cancer screening. However, we were concerned with the quality of reporting in this meta-analysis. Bretthauer et al1 did not report registering their review protocol. Furthermore, they did not perform a risk of bias assessment on all the trials included in their review, nor didtheyuseGRADE (GradingofRecommendations, Assessment …

The paper by Walter and Balakrishnan (1) notes that the standard inverse-variance weights in metaanalysis can be considered as biased because the sample variance is not equal to the true variance. The authors therefore propose that a bias-corrected weighting scheme should be used in metaanalyses. After careful examination as indicated below, we think that this is unnecessary. As we show in this response, for most considered small meta-analyses the proposed bias-corrected approach yields equivalent results to the standard inverse-variance weighted meta-analysis. It differs from standard meta-analysis only where study effect varies with study size.

BACKGROUND Although postprocedure blood pressure (BP) correlates with outcome in patients undergoing endovascular thrombectomy (EVT), the optimal target is unknown. METHODS We performed a pilot randomized‐controlled clinical trial enrolling participants with persistently elevated BP after successful EVT. Participants were randomized within 1 hour from the end of EVT to either intensive (systolic BP target <140 mmHg) or standard BP target (systolic BP <180 mmHg) for 48 hours. The main end point was feasibility, which was assessed with the enrollment rate and adherence to allocated BP target. Exploratory end points included neurologic deterioration, functional improvement, intracranial hemorrhage, and flow dynamics detected by transcranial Doppler ultrasonography. We included the outcomes of our trial in an aggregate data meta‐analysis of randomized‐controlled clinical trials evaluating the …

A scoping review, the aim of which is to map the existing methodological evidence on how to conduct a pairwise or network meta-analysis in the context of updated or living systematic reviews

The original (2009) PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) reporting guideline, was created to improve transparency and reproducibility in systematic reviews. PRISMA was later extended to guide reporting of other research synthesis methodologies including scoping reviews (ScRs) in 2018. However, important advances in ScR methods (eg, data extraction techniques, evidence synthesis and automation tools) along with the updated PRISMA 2020 guideline for systematic reviews call for a considerable update to the PRISMA-ScR guideline to ensure continued rigor and fit for purpose.

Self-management interventions (SMIs) may enhance heart failure (HF) outcomes and address challenges associated with disease management. This study aims to review randomized evidence and identify knowledge gaps in SMIs for adult HF patients. Within the COMPAR-EU project, from 2010 to 2018, we conducted searches in the databases MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO. We performed a descriptive analysis using predefined categories and developed an evidence map of randomized controlled trials (RCTs). We found 282 RCTs examining SMIs for HF patients, comparing two to four interventions, primarily targeting individual patients (97%) globally (34 countries, only 31% from an European country). These interventions involved support techniques such as information sharing (95%) and self-monitoring (62%), often through a mix of in-person and remote sessions (43%). Commonly assessed outcomes included quality of life, hospital admissions, mortality, exercise capacity, and self-efficacy. Few studies have focused on lower socio-economic or minority groups. Nurses (68%) and physicians (30%) were the primary providers, and most studies were at low risk of bias in generating a random sequence for participant allocation; however, the reporting was noticeably unclear of methods used to conceal the allocation process. Our analysis has revealed prevalent support techniques and delivery methods while highlighting methodological challenges. These findings provide valuable insights for researchers, clinicians, and policymakers striving to optimize SMIs for individuals living with HF.

ObjectiveTo compare myocarditis/pericarditis risk after COVID-19 mRNA vaccination versus SARS-CoV-2 infection, and to assess if myocarditis/pericarditis risk varies by vaccine dosing interval.MethodsIn this retrospective cohort study, we used linked databases in Quebec, Ontario, and British Columbia between January 26, 2020, and September 9, 2021. We included individuals aged 12 or above who received an mRNA vaccine as the second dose or were SARS-CoV-2-positive by RT-PCR. The outcome was hospitalization/emergency department visit for myocarditis/pericarditis within 21 days of exposure. We calculated age- and sex-stratified incidence ratios (IRs) of myocarditis/pericarditis following mRNA vaccination versus SARS-CoV-2 infection. We also calculated myocarditis/pericarditis incidence by vaccine type, homologous/heterologous schedule, and dosing interval. We pooled province-specific …

Meta-analysis is a statistical method used to combine results from multiple studies, providing a quantitative summary of their findings. One of the fundamental decisions in conducting a meta-analysis is choosing an appropriate model to estimate the overall effect size and its CI. In this article, we focus on the common-effect (also referred to as the fixed-effect) model, and in a companion article, the random-effects model. These models are the two prevailing meta-analysis models employed in the literature. In this article, we outline the key assumption underlying the common-effect model, describe different common-effect methods (ie, inverse variance, Peto, and Mantel-Haenszel), and highlight characteristics of the meta-analysis that should be considered when selecting a method. Furthermore, we demonstrate the application of these methods to a dataset. Understanding the common-effect model is important for …

IntroductionNetwork meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of the comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs.Methods and analysisWe included papers that present items related to bias, reporting or methodological quality, papers assessing the quality of NMAs, or method papers. We searched MEDLINE, the Cochrane Library and unpublished literature (up to July 2020). We extracted items related to bias in NMAs. An item was excluded if it related to general systematic review quality or bias and was included in currently available tools such as ROBIS or AMSTAR 2. We reworded items, typically structured as questions, into concepts (i.e. general notions).ResultsOne hundred eighty-one articles …

Introduction/Background Around one fifth of endometrial cancers (EC) are diagnosed in premenopausal women. The standard treatment for EC, its precursor: endometrial hyperplasia with atypia (EHA), and unresolved endometrial hyperplasia (EH) is a hysterectomy. Fertility-sparing treatment has more recently been recognised as a viable option for those who wish to conceive. ESGO guidelines published in 2023 suggest that both oral progesterones and progesterone-based intra-uterine systems (LNG-IUS) are acceptable therapies, and there is no conclusive evidence as to the best treatment. Our aim was to undertake a systematic review and meta-analysis of the available literature, in order to determine the most effective treatment.Methodology MEDLINE, EMBASE, and ongoing trial registries were systematically searched from inception to November 2023. Randomised (RCTs) and Non-Randomised studies …

Objective To compare the cost‐effectiveness of different treatments for cervical intraepithelial neoplasia (CIN). Design A cost‐effectiveness analysis based on data available in the literature and expert opinion. Setting England. Population Women treated for CIN. Methods We developed a decision‐analytic model to simulate the clinical course of 1000 women who received local treatment for CIN and were followed up for 10 years after treatment. In the model we considered surgical complications as well as oncological and reproductive outcomes over the 10‐year period. The costs calculated were those incurred by the National Health Service (NHS) of England. Main outcome measures Cost per one CIN2+ recurrence averted (oncological outcome); cost per one preterm birth averted (reproductive outcome); overall cost per one adverse oncological or reproductive outcome averted. Results For young women …

Introduction/Background The efficacy of HPV vaccination on the risk of recurrent cervical disease related to HPV infection in individuals undergoing local surgical treatment constitutes a matter of debate.Methodology In this study we screened data sources for studies reporting on the risk of recurrent disease related to HPV infection after local surgical treatment of preinvasive disease in individuals who were vaccinated. Independent and in duplicate data extraction were performed. Pooled risk ratios and 95% confidence intervals were calculated with a random effects meta-analysis model.Results Eighteen studies reported data from a non-vaccinated group and were included in the meta-analyses. The risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) was reduced in individuals who were vaccinated compared with those who were not vaccinated (11 studies, 19 909 participants; risk ratio …

BackgroundNetwork meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We aimed to develop a risk of bias (RoB) tool to assess NMAs (RoB NMA tool). An international steering committee recommended that the RoB NMA tool to be used in combination with the Risk of Bias in Systematic reviews (ROBIS) tool (i.e. because it was designed to assess biases only) or other similar quality appraisal tools (eg, A MeaSurement Tool to Assess systematic Reviews 2 [AMSTAR 2]) to assess quality of systematic reviews. The RoB NMA tool will assess NMA biases and limitations regarding how the analysis was planned, data were analysed and results were presented, including the way in which the evidence was assembled and interpreted.ObjectivesConduct (a) a Delphi process to determine expert opinion on an item’s inclusion and (b) a knowledge user …

Self-management interventions (SMIs) may be promising in the treatment of Diabetes Mellitus Type 2 (T2DM). However, accurate comparisons of their relative effectiveness are challenging, partly due to a lack of clarity and detail regarding the intervention content being evaluated. This study summarizes intervention components and characteristics in randomized controlled trials (RCTs) related to T2DM using a taxonomy for SMIs as a framework and identifies components that are insufficiently incorporated into the design of the intervention or insufficiently reported. Following evidence mapping methodology, we searched MEDLINE, CINAHL, Embase, Cochrane, and PsycINFO from 2010 to 2018 for randomized controlled trials (RCTs) on SMIs for T2DM. We used the terms ‘self-management’, ‘adult’ and ‘T2DM’ for content. For data extraction, we used an online platform based on the taxonomy for SMIs. Two independent reviewers assessed eligible references; one reviewer extracted data, and a second checked accuracy. We identified 665 RCTs for SMIs (34% US, 21% Europe) including 164,437 (median 123, range 10–14,559) adults with T2DM. SMIs highly differed in design and content, and characteristics such as mode of delivery, intensity, location and providers involved were poorly described. The majority of interventions aimed to improve clinical outcomes like HbA1c (83%), weight (53%), lipid profile (45%) or blood pressure (42%); 27% (also) targeted quality of life. Improved knowledge, health literacy, patient activation or satisfaction with care were hardly used as outcomes (<16%). SMIs most often used education (98%), self-monitoring (56 …

High-quality systematic reviews (SRs) of both new and existing health technologies are vital to inform clinical practices and healthcare decisionmaking. This has been recognised by global entities such as the World Health Organization and national healthcare policy agencies like the Canadian Agency for Drugs and Technologies in Health, the National Institute for Health and Care Excellence in the United Kingdom, and the National Health and Medical Research Council in Australia. These SRs serve as the foundation for evidence-based practices and policies, which is reflected in the increasing number of publications in recent years. 1SRs comparing more than one intervention are often of interest to knowledge users (eg, health care professionals and patients). 2 This includes, for instance, selecting from a range of medications, such as atypical antipsychotics, haloperidol and dexmedetomidine, for the …

BackgroundChronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.MethodsDesign: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.Eligibility criteria: Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).Information sources: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database’s inception to March 2020.Outcome measures: Sustainability, fidelity, adherence of KT interventions for CDM practice, quality …