170,340 research outputs found
Erratum:Lifestyle interventions for weight management in people with serious mental illness: A systematic review with meta-analysis, trial sequential analysis, and meta- regression analysis exploring the mediators and moderators of treatment effects (Psychotherapy and Psychosomatics (2019) (1-13) DOI: 10.1159/000502293)
No full textIn the article by Speyer H., Jakobsen A.S., Westergaard C., Norgaard H.C.B., Pisinger C., Krogh J., Hjorthoj C., Nordentoft M., Gluud C., Correll C.U., Jorgensen K.B. entitled "Lifestyle Interventions for Weight Management in People with Serious Mental Illness: A Systematic Review with Meta-Analysis, Trial Sequential Analysis, and Meta- Regression Analysis Exploring the Mediators and Moderators of Treatment Effects" [Psychother Psychosom. 2019 Sep 13: 1-13, DOI: 10.1159/000502293], the correct sequence of the authors should read as follows: Speyer H., Jakobsen A.S., Westergaard C., Norgaard H.C.B., Jorgensen K.B., Pisinger C., Krogh J., Hjorthoj C., Nordentoft M., Gluud C., Correll C.U.</p
FibroTest, transient elastography method, and combined FibroTest and transient elastography method for diagnosis of severe hepatic fibrosis and cirrhosis in adults with chronic hepatitis C
No full textThis is the protocol for a review and there is no abstract. The objectives are as follows: To determine the diagnostic accuracy of FibroTest, transient elastography method, combined FibroTest and transient elastography method, no matter the sequence, using liver biopsy as reference standard, for assessment of severe hepatic fibrosis and cirrhosis in adults with chronic hepatitis C without any co-infections such as hepatitis B, HIV, and alcoholic liver disease. To compare the accuracy of FibroTest, transient elastography method, combined FibroTest and transient elastography method, for assessment of hepatic fibrosis in adults with chronic hepatitis C. To explore heterogeneity analysing the following study factors: different grade of inflammation according to the liver biopsy; different lengths of liver biopsy sample; different number of portal tracts included in a liver biopsy sample; different serum levels of ALT activity. different grade of inflammation according to the liver biopsy; different lengths of liver biopsy sample; different number of portal tracts included in a liver biopsy sample; different serum levels of ALT activity
Comment on: "Cell Therapy for Heart Disease: Trial Sequential Analyses of Two Cochrane Reviews"
No full textTrial Sequential Analysis is a frequentist method to help researchers control the risks of random errors in meta-analyses (1). Fisher and colleagues used Trial Sequential Analysis on cell therapy for heart diseases (2). The present article discusses the usefulness of Trial Sequential Analysis and its dependence on the choice of the parameters for calculation of the required information size and the adjacent monitoring boundaries, and comments on the approach by Fisher et al. (2)
Editorial: In vino veritas : Transient elastography for staging liver fibrosis in alcoholic liver disease : Authors' reply
No full textSystematic review with meta-analysis : Diagnostic accuracy of transient elastography for staging of fibrosis in people with alcoholic liver disease
No full textBackground The progression of hepatic fibrosis into cirrhosis is a main prognostic factor for survival in people with alcoholic liver disease. The range of cut-off values characterising the stage of hepatic fibrosis seems to be dependent on the aetiology of the liver disease. Aims To determine the diagnostic accuracy of transient elastography (the index test) for diagnosis of fibrosis in alcoholic liver disease when compared with liver biopsy (the reference standard), using the METAVIR scoring system. To establish the optimal cut-off values for the hepatic fibrosis stages. Methods We followed Cochrane Methodology for diagnostic test accuracy reviews. We identified 14 studies. Among the study participants with alcoholic liver disease, 834 provided numerical data for analysis (August 2014). Only half of the studies were monoaetiology studies. We used the bivariate model and estimated the summary sensitivities and summary specificities. Hence, we calculated the summary likelihood ratios (LRs) to rule in or rule out hepatic fibrosis. We investigated pre-defined sources of heterogeneity. Results Severe fibrosis (F3 or worse): summary (95% CI) sensitivity 0.92(0.89-0.96) and specificity 0.70(0.61-0.79); LR+ 3.1(2.1-4.1), LR- 0.11(95% CI 0.06-0.16). Cirrhosis (F4): summary (95% CI) sensitivity of 0.95(0.87-0.98) and specificity 0.71(0.56-0.82); LR+ 3.3(2.1-5.0); LR- 0.07(0.03-0.19). Conclusions Transient elastography may be used as a diagnostic method to exclude cirrhosis or severe fibrosis when the test is negative. Cut-off values of around 12.5 kPa for cirrhosis may be used in clinical practice, but caution is needed, as the values reported in the review are not yet prospectively validated
Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy
No full textThis is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To determine the diagnostic accuracy of total serum bile acids or total serum bile acids profile, or both for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women presenting with pruritus. To compare the diagnostic accuracy of total serum bile acids and each component of serum bile acid profile, considered independently or in combination, in diagnosing intrahepatic cholestasis of pregnancy; to define the optimal cut-off values for these; and to investigate possible sources of heterogeneity
Essential phospholipids for people with non-alcoholic fatty liver disease (Protocol)
No full textNon-alcoholic fatty liver disease (NAFLD) covers conditions related to accumulation of fat in the liver if specific causes, such as significant alcohol consumption, long-term use of a steatogenic medication, or monogenic hereditary disorders can be excluded (WGO 2014). Non-alcoholic fatty liver disease features a wide spectrum of histologically conditions, from simple accumulation of fat ('fatty liver' or hepatic steatosis) to non-alcoholic steatohepatitis (NASH), liver fibrosis, and liver cirrhosis with clinical consequences (Brunt 2011; McPherson 2015; Bertot 2016). Simple hepatic steatosis is defined as when the fat, built up in the epithelial cells of the liver, is at least 5% of the liver weight, and the parenchymal cells and liver structure are intact. Non-alcoholic fatty liver (NAFL) is defined as the presence of hepatic steatosis with no evidence of hepatocellular injury in the formof ballooning of the hepatocytes. Non-alcoholic steatohepatitis is defined as the presence of hepatic steatosis and inflammation with hepatocyte injury (ballooning) with or without fibrosis (Brunt 2011). Nonalcoholic fatty liver disease is considered to be a clinical manifestation of the metabolic syndrome, that is the co-occurrence of metabolic risk factors for both type 2 diabetes and cardiovascular disease (abdominal obesity, hyperglycaemia, dyslipidaemia, and hypertension) (Dyson 2014;Mikolasevic 2016; AASLD NAFLD 2018). The prevalence of NAFLD is increasing, but only a small number of affected people develop inflammation, which may be followed by fibrosis and cirrhosis, possibly requiring liver transplantation (Bertot 2016; Younossi 2016). The life expectancy in people with hepatic steatosis is reported to be similar to the life expectancy of the general population (Lazo 2011)
Total serum bile acids or serum bile acid profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy
No full textBackground
Intrahepatic cholestasis of pregnancy is a pregnancy-specific liver disorder, possibly associated with an increased risk of severe fetal adverse events. Total serum bile acids (TSBA) concentration, alone or in combination with serum aminotransferases, have been the most often used biomarkers for the diagnosis of intrahepatic cholestasis of pregnancy in clinical practice. Serum bile acid profile, composed of primary or secondary, conjugated or non-conjugated bile acids, may provide more specific disease information.
Objectives
To assess and compare, independently or in combination, the diagnostic accuracy of total serum bile acids or serum bile acids profile, or both, for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women, presenting with pruritus. To define the optimal cut-off values for components of serum bile acid profile; to investigate possible sources of heterogeneity.
Search methods
We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test Accuracy Studies Register, the Cochrane Library, MEDLINE Ovid, Embase Ovid, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, BIOSIS, CINAHL, two Chinese databases (CKNI, VIP), Latin American and Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SciELO), Evidence Search: Health and Social Care by the National Institute for Health and Care Excellence (NICE), the World Health Organization (WHO) Reproductive Health Library (RHL), and the Turning Research into Practice database (TRIP). The most recent date of search was 6 May 2019. We identified additional references by handsearching the references of articles, meta-analyses, and evidence-based guidelines retrieved from the computerised databases, online trial registries, and grey literature through OpenSIGLE, National Technical Information Service (NTIS), ProQuest Dissertations & Thesis Database, and Index to Theses in Great Britain and Ireland.
Selection criteria
Prospective or retrospective diagnostic case-control or cross-sectional studies, irrespective of publication date, format, and language, which evaluated the diagnostic accuracy of total serum bile acids (TSBA) or components of serum bile acid profile for the diagnosis of intrahepatic cholestasis of pregnancy in pregnant women of any age or ethnicity, in any clinical setting, symptomatic for pruritus.
Data collection and analysis
We selected studies by reading titles, abstracts, or full texts, and assessing their fulfilment of our inclusion criteria. We emailed primary authors to request missing data or individual participant data. Having extracted data from each included study, we built the two-by-two tables for each primary study and for all the index tests considered. We estimated sensitivity and specificity with their 95% confidence intervals (CI). We presented data in coupled forest plots, showing sensitivities and specificities of each study, and we plotted the studies in the Receiver Operating Characteristic (ROC) space. We performed meta-analyses adopting the hierarchical summary ROC model (HSROC) or the bivariate model to meta-analyse the data. We made indirect comparisons of the considered index tests by adding the index tests as covariates to the bivariate or HSROC models. We performed heterogeneity analysis and sensitivity analysis on studies assessing TSBA accuracy. We used Review Manager 5 (RevMan 5) and SAS statistical software, release 9.4 (SAS Institute Inc., Cary, NC, USA), to perform all statistical analyses. We used QUADAS-2 domains to assess the risk of bias of the included studies.
Main results
Our search yielded 5073 references, but at the end of our selection process, only 16 studies fulfilled the review inclusion criteria. Nine of these provided individual participant data. We analysed only data concerning TSBA, cholic acid (CA), glycocholic acid (GCA), chenodeoxycholic acid (CDCA), and CA/CDCA because the remaining planned index tests were assessed in few studies. Only one study had low risk of bias in all four QUADAS-2 domains. The most biased domains were the patient sampling and the reference standard domains. When considering all studies with a cut-off of 10 mu mol/L, TSBA overall sensitivity ranged from 0.72 to 0.98 and specificity ranged from 0.81 to 0.97. After a sensitivity analysis excluding case-control studies, TSBA sensitivity ranged from 0.48 to 0.66 and specificity from 0.52 to 0.99. After a sensitivity analysis excluding studies in which TSBA was part of the reference standard, TSBA sensitivity ranged from 0.49 to 0.65 and specificity from 0.53 to 0.99. We found the estimates of the overall accuracy for some serum bile acid components (CA, GCA, CDCA, and CA/CDCA) to be imprecise, with the CI for sensitivity and specificity very wide or impossible to calculate. Indirect comparisons between serum bile acid profile components and TSBA were not statistically significant. None of the heterogeneity analysis performed was statistically significant, except for the timing of assessment of TSBA (onset of symptoms, peak value among multiple assessments, delivery) but without clinically relevant results. We could not analyse the diagnostic accuracy of combinations of index tests because none of the included studies carried them out, and because of the small number of included studies.
Authors' conclusions
The overall high risk of bias, the existing concern regarding applicability of the results in clinical practice, and the great heterogeneity of the results in the included studies prevents us from making recommendations and reaching definitive conclusions at the present time. Thus, we do not find any compelling evidence to recommend or refute the routine use of any of these tests in clinical practice. So far, the diagnostic accuracy of TSBA for intrahepatic cholestasis of pregnancy might have been overestimated. There were too few studies to permit a precise estimate of the accuracy of serum bile acid profile components. Further primary clinical research is mandatory. We need both further phase II and phase III diagnostic studies
Glucocorticosteroids for people with alcoholic hepatitis
No full textThis is the protocol for a review and there is no abstract. The objectives are as follows: To assess the benefits and harms of glucocorticosteroids in people with alcoholic hepatitis
Going Beyond Counting First Authors in Author Co-citation Analysis
No full textThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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