Network meta-analysis (NMA) is a statistical technique that integrates data from multiple clinical studies and compares the efficacy and safety of multiple interventions, which can provide pro and con ranking results for all intervention options in the evidence network and provide direct evidence support for clinical decision-making. At present, NMA is usually based on the aggregation of the same type of data set, and there are still methodological and software difficulties in achieving cross-study design and cross-data format data set merging. The crossnma package of R programming language is based on Bayesian framework and Markov chain Monte Carlo algorithm, extending the three-level hierarchical model to the standard NMA data model to achieve differential merging of varied data types. The crossnma package fully considers the impact of risk bias caused by the combination of different types of data on the results by introducing model variables. In addition, the package provides functions such as result output and easy graphing, which makes it possible to combine NMA across study designs and evidence across data formats. In this study, the model based on crossnma package method and software operation will be demonstrated and explained through the examples of four individual participant datasets and two aggregate datasets.
ObjectiveTo systematically evaluate the efficacy and safety of different low-molecular-weight heparins (LMWHs) in improving pregnancy outcomes in patients with recurrent abortion. MethodsThe PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to July 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 25 RCTs involving 4 631 patients were included. Enoxaparin, dalteparin, nadroparin, and tinzaparin were included. The results of network meta-analysis showed that the live birth rate of the tinzaparin was higher than that of enoxaparin and dalteparin. The live birth rate in nadroparin was higher than that in enoxaparin and dalteparin. The cumulative sorting probability showed that tinzaparin ranked best for improving the live birth rate, nadroparin ranked best for reducing the miscarriage rate, and enoxaparin ranked best for reducing the preterm birth rate. ConclusionCurrent evidence suggests that tinzaparin and nadroparin may be the best choice for improving pregnancy outcomes in patients with recurrent abortion. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the efficacy of different stimulation modalities of repetitive transcranial magnetic stimulation (rTMS) combined with SSRI in improving depressed mood after stroke using network meta-analysis. MethodsThe PubMed, EMbase, Cochrane Library, Web of Science, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to October 1, 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then performed by using R 4.2.1software. ResultsA total of 25 RCTs involving 2 152 patients were included. Four types of rTMS stimulation combined with SSRIs were included: high-frequency stimulation of the left dorsolateral prefrontal (l-DLPFC), low-frequency stimulation of l-DLPFC, low-frequency stimulation of the right dorsolateral prefrontal (r-DLPFC), and low-frequency stimulation of the bilateral DLPFC. The results of the network meta-analysis showed that the effect of combining four stimulation methods with SSRI in treating depression was better than that of SSRI alone (P<0.05). Probability sorting results showed that low-frequency stimulated bilateral DLPFC (88.9%) > low-frequency stimulated l-DLPFC (63.1%) > high-frequency stimulation l-DLPFC (57.1%) > low-frequency stimulation r-DLPFC (40.4%). There was no statistically significant difference in the incidence of adverse reactions between the four stimulation methods combined with SSRI and the use of SSRI alone (P>0.05). Conclusion rTMS combined with SSRIs is better than SSRIs alone in improving depressed mood after stroke. Low-frequency rTMS stimulation of bilateral DLPFC may be the best. Meanwhile, the safety of different stimulation methods is good.
The goal of JAGS (Just Another Gibbs Sampler) software is to remedy the short of BUGS software that unable to running on a system besides Microsoft Windows, such as Unix or Linux. JAGS owns independent computing function and formula of Bayesian theory; it is mischaracterized with simple user interface, good system compatibility, smoother operation, and good interactivity with other programming software. However, due to the limitations of lacking function for results data reading and unscrambling and graph plotting, the popularization and application of JAGS software is restricted. Calling JAGS software from R software through R2jags package, rjags package, or runjags package can overcome these limitations. The operating principle of these three packages is calling JAGS software in the framework of the R software, they have similar functional structure and all have easy maneuverability, concise command, perfect function of data reading and unscrambling and graph drawing; however, there are some differences among them in practice. This article introduces how to performing network meta-analysis by calling JAGS software from R through these three packages.
ObjectiveTo systematically review the efficacy of aerobic training, resistance training and aerobic training combined with resistance training on non-dialysis patients with chronic kidney diseases. MethodsPubMed, The Cochrane Library, EMbase, EBSCO, Web of Science, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) of three types of exercise therapy on patients with chronic kidney disease from January 2012 to January 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 RevMan 5.4 software and R software. ResultsA total of 22 RCTs involving 1 633 patients were included. The results of network meta-analysis showed that: compared with the control group, aerobic training, and resistance training reduced resting systolic blood pressure; aerobic training, resistance training reduced resting diastolic blood pressure; aerobic training reduced total cholesterol levels; aerobic training improved peak oxygen uptake; aerobic training combined with resistance training improved six-minute walking test. Aerobic training, resistance training, and aerobic training combined with resistance training improved glomerular filtration rate. The probability sorting results showed that aerobic training had the most significant effect on the improvement of peak oxygen uptake, C-reactive protein, total cholesterol, low-density lipoproteins, and high-density lipoproteins; resistance training had the most significant effect on the improvement of systolic blood pressure, diastolic blood pressure and glomerular filtration rate; aerobic exercise combined with resistance training had the most significant effect on the improvement of body mass index, triglycerides, and six-minute walking test. ConclusionCurrent evidence shows that aerobic training has an advantage in reducing total cholesterol levels and increasing peak oxygen uptake, resistance training has an advantage in improving blood pressure and glomerular filtration rate and aerobic training combined with resistance training has an advantage in improving walking ability of patients with non-dialysis chronic kidney disease.
Objective To systematically review the effect of different nutrient interventions on the physical function of elderly people with frailty through network meta-analysis. Methods The PubMed, Cochrane Library, EMbase and Web of Science were electronically searched to collect randomized controlled trials of different nutrient interventions on physical function of the elderly with frailty, from database inception to June 30, 2022. 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 ADDIS 1.16.8, GeMTC 14.3, and Stata 15.0 software. Results A total of 13 studies involving 1 144 patients were included. There was no statistically significant difference in handgrip strength, time up to go test, gait speed, and short physical performance battery (SPPB) among different nutrient interventions. Significant differences were not found in vitamin D+ whey protein (VDWP) vs. placebo and Leu vs. placebo in handgrip strength, or VDWP vs. placebo in SPPB. The probability ranking diagram showed that the most effective of handgrip strength, time up to go test, gait speed, and SPPB were milk protein concentrate (MPC80), L-carnitime (L-Car), leucine (Leu), and MPC80, respectively. Conclusion The current evidence suggests that nutritional intervention did not significantly improve physical function in the frail elderly. MPC80, Leu, L-Car, and VDVEWP may play a role in improving the physical function of frail elderly people. Nutritional support programs that increase the above nutrients, combined with exercise training may become a better way to improve the physical function of frail elderly.
ObjectiveTo systematically review the efficacy of non-pharmacological interventions to reduce fear of childbirth. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of non-pharmacological interventions to reduce fear of childbirth from inception to December 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies; then, a network meta-analysis was performed using Stata 15.0 software. ResultsA total of 19 RCTs involving 3 409 patients were included. Ten non-pharmacological interventions (prenatal education, scenario-based health education, psychological guidance, yoga training, hypnosis, mobile learning education, cognitive behavioral therapy, physical relaxation guidance, breathing guidance, and usual care) were included. The results of the reticulated meta-analysis of the Wijma Delivery Expectancy Questionnaire (W-DEQ-A) showed that the rankings of the interventions were as follows: prenatal education > yoga training > cognitive behavioral therapy > situational simulation health education > psychological guidance > physical relaxation guidance > conventional care. The results of the Wijma Experience of Childbirth Questionnaire (W-DEQ-B) mesh meta-analysis showed that the rankings of the interventions were as follows: mobile learning education > prenatal education > scenario-based health education > cognitive behavioral therapy > breathing instruction > hypnosis > psychological instruction > physical relaxation instruction > usual care. ConclusionThe current evidence suggests that prenatal education, mobile learning education, situational simulation health education, and yoga training may be effective interventions in improving maternal fear of childbirth. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo assess the comparative efficacy of all kinds of selenium supplementation in the treatment of patients with Kashin-Beck disease (KBD) by network meta-analysis. MethodsWe searched seven electronic databases including PubMed, EMbase, The Cochrane Library (Issue 7, 2016), CBM, VIP, WanFang Data and CNKI databases up to July 2016. All randomized controlled trials (RCTs) assessing the effect of selenium supplementation on KBD were included. Two reviewers independently screened literatures, extracted data and assessed the risk bias of included studies, and then meta-analysis was performed by using Stata13.1 software. ResultsA total of 16 RCTs involving 2 883 participants were included. Direct meta-analysis comparison showed that:Compared with placebo or blank group, sodium selenite (OR=5.00, 95%CI 3.21 to 7.78), selenium supplement salt (OR=7.60, 95%CI 2.34 to 24.67), and combination of sodium selenite and vitamin E (OR=11.05, 95%CI 2.61 to 46.80) had higher metaphysis X-ray improvement (P < 0.05). Ranking on efficacy indicated that combination of sodium selenite and vitamin E were highest, followed by selenium supplement salt, sodium selenite, sodium selenite plus vitamin C, vitamin C, and placebo/blank. ConclusionBased on the results of network meta-analysis, selenium supplement (sodium selenite, combination of sodium selenite and vitamin C, combination of sodium selenite and vitamin E, as well as selenium salt) is more effective than placebo or no treatment in promoting the repairement of metaphysis impairment. The effect of combination of sodium selenite and vitamin E are highest.
ObjectiveTo evaluate the efficacy of different non-pharmacological interventions on cognitive function in elderly patients with mild cognitive impairment by the network meta-analysis. MethodsThe PubMed, Embase, Cochrane Library, CINAHL, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) related to the objectives from inception to November 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. The network meta-analysis was then performed by using Stata 16.0 and Open BUGS 3.2.3 software. ResultsA total of 43 RCTs involving 2 986 patients were included, which involved 8 non-drug intervention methods. The best probability ranking results of the network meta-analysis showed that on the simple mental state scale (MMSE) scores: rTMS > acupressure > acupuncture therapy > exercise therapy > cognitive training > multicomponent intervention > VR > conventional care > health education, and on the Montreal cognitive assessment scale (MoCA) scores: VR > exercise therapy > rTMS > acupuncture therapy > acupressure > cognitive training > health education > conventional care. Conclusion Current evidence shows that rTMS, acupressure, VR, exercise therapy and acupuncture may be effective interventions to improve cognitive function in elderly patients with mild cognitive impairment. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
The summary of finding (SoF) table for network meta-analysis (NMA) was developed by the GRADE working group to facilitate and consolidate understanding NMA findings and GRADE certainty of evidence. This paper introduces the development process, the structure of NMA-SoF and limitations. A NMA publication was presented as an example to comprehensively illustrate the application of the NMA-SoF table.