The netmeta package is specialized for implementing network meta-analysis. This package was developed based on the theories of classical frequentist under R language framework. The netmeta package overcomes some difficulties of the software and/or packages based on the theories of Bayesian, for these software and/or packages need to set prior value when conducting network meta-analysis. The netmeta package also has the advantages of simple operation process and ease to operate. Moreover, this package can calculate and present the individual matched and pooled results based on the random and fixed effect model at the same time. It also can draw forest plots. This article gives a briefly introduction to show the process to conduct network meta-analysis using netmeta package.
BUGSnet is a powerful R project package for Bayesian network meta-analysis. The package is based on JAGS and enables high-quality Bayesian network meta-analysis according to recognized reporting guidelines (PRISMA, ISPOR-AMPC-NCA and NICE-DSU). In this paper, we introduced the procedure of the BUGSnet package for Bayesian network meta-analysis through an example of network meta-analysis of steroid adjuvant treatment of pemphigus with continuous or dichotomous data.
ObjectiveTo systematically review the effect of different psychological intervention methods on depressive symptoms in patients with inflammatory bowel disease. MethodsPubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials(RCTs) on psychological interventions on depression of patients with inflammatory bowel disease from inception to January 12, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Network meta-analysis was then conducted by using software Stata and GeMTC. ResultsA total of 18 articles, 1 567 patients and 6 psychological intervention methods were included. The results of the network meta-analysis showed that, compared with conventional nursing, music therapy, mindfulness therapy and cognitive behavioral therapy had statistically significant differences in the intervention effect of depression in patients with inflammatory bowel disease (P<0.05); Among the six psychological intervention methods included, there was a statistically significant difference in relaxation therapy compared with music therapy, writing expression and mindfulness therapy (P<0.05); The difference between cognitive behavioral therapy and music therapy and mindfulness therapy was statistically significant (P<0.05), while there was no statistically significant difference in other interventions (P>0.05). The SUCRA ranking probability chart showed that music therapy was the best intervention method for depression in patients with inflammatory bowel disease, followed by mindfulness therapy and cognitive behavioral therapy. ConclusionThe current evidence suggests that music therapy has an advantage in relieving depression in patients with inflammatory bowel disease, followed by mindfulness therapy or cognitive behavioral therapy. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
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 and safety of different low-molecular-weight heparins (LMWHs) for prevention of thromboembolic events in patients with atrial fibrillation (AF).MethodsPubMed, The Cochrane Library, EMbase, CBM, CNKI, VIP and WanFang Data databases were electronically searched to collect randomized clinical trials (RCTs) on efficacy and safety of different low-molecular-weight heparins (LMWHs) in preventing thrombotic diseases in patients with atrial fibrillation from inception to March 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed by using Stata 16.0 software.ResultsA total of 11 RCTs involving 7 400 patients who were treated with enoxaparin, dalteparin, or tinzaparin to prevent thromboembolic events were included. The results of network meta-analysis showed that: in patients with AF and perioperative AF patients, there were no statistical differences in the incidence of stroke, TIA, major bleeding, minor bleeding, and all-cause mortality caused by dalteparin, enoxaparin, and tinzaparin. Furthermore, the surface under the cumulative ranking area (SUCRA) showed that enoxaparin was superior for prevention of stroke and TIA than dalteparin and tinzaparin. As for major bleeding, minor bleeding, and all-cause death, dalteparin treatment was superior than enoxaparin.ConclusionsCurrent evidence showed enoxaparin to be a viable option for high ischemic risk AF patients requiring LWMH treatment, while dalteparin to be a viable option for those with bleeding high risk. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
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.
Objectives To systematically review the preventive effects of different pressure relief devices. Methods Databases including PubMed, The Cochrane Library, Web of Science, EMbase, CBM, CNKI, VIP and WanFang Data were searched to collect randomized control trials (RCTs) on the preventive effects of pressure relief devices for the surgical pressure sore from inception to December 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R 3.5.0 software, Stata 13.0 and JAGS 3.4.0 software. Results A total of 20 RCTs involving 4 183 patients were included. The network meta-analysis showed that micropulse dynamic pad was superior to standard pad. The gel pad was superior to sponge pad. The standard pad and cotton gauze pad. The foam dressing was superior to gel pad. All of the differences were statistically significant. The results of the ranking probability plot suggested foam dressing as an optimal resolution for preventing surgical pressure sore. Conclusions According to the network meta-analysis and rankings, foam dressing is superior to other decompression devices in preventing surgical pressure sores.
Objective To systematically review the efficacy and safety of 3-month sustained releasing gonadotropin-releasing hormone agonist (GnRHa) (GnRHa 3M) and 1-month sustained releasing GnRHa (GnRHa 1M) in the treatment of pre-menopausal females with hormone receptor-positive breast cancer. Methods Databases including CNKI, WanFang Data, PubMed, EMbase and Web of Science were electronically searched to collect randomized controlled trials(RCTs) of GnRHa in the treatment of hormone receptor-positive breast cancer from inception to May 18th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. The gemtc software package in R 3.6.1 software and Stata 15.0 software were used for network meta-analysis. Results A total of 11 RCTs including 7 484 patients were included. The network meta-analysis results showed that there was no significant difference between GnRHa 3M and GnRHa 1M in E2 level (MD=−1.3, 95%CI −13 to 9.6), DFS (HR=1.2, 95%CI 0.88 to 1.7) and OS (HR=2.0, 95%CI 0.75 to 4.9). For safety, there was no significant difference between the two groups (RR=1.0, 95%CI 0.25 to 4.2). Conclusion Current evidence shows that the efficacy and safety of GnRHa 3M is similar to that of GnRHa 1M. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo introduce sensitivity and homogeneity tests in network meta-analysis and its implementation in R software. MethodsUsing an example, we performed sensitivity analysis by comparing the random effect model with the fixed effect model. Homogeneity analysis was performed using metaphor package and combinat package in R software. ResultsThe results of the two models were similar, and the data was steady. The results of homogeneity analysis showed that the confidential intervals in all loops were crossed over with blank value; and direct and indirect estimates of the effects in network meta-analysis were not significantly different, with good homogeneity. ConclusionNetwork meta-analysis is a kind of indirect comparison analysis method, and its sensitivity is especially important. The introduction of homogeneity makes network meta-analysis more accurate. Using R software for sensitivity and homogeneity analysis in network meta-analysis is a feasible method.
ObjectivesTo compare the effects of different bariatric surgeries on reducing hemoglobin A1c (HbA1c) in overweight/obese patients with type 2 diabetes.MethodsRandomized controlled trials (RCTs) of bariatric surgery were systematically searched in PubMed, EMbase, The Cochrane Library, ClinicalTrials.gov, CNKI, WanFang Data and VIP databases from inception to February 20th, 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using Stata 14.0 software and R 3.6.2 software.ResultsA total of 24 RCTs were included. Compared with non-surgical treatments, 5 out of 9 procedures significantly reduced HbA1c, and the probability order for the effect was as follows: sleeve gastrectomy with transit bipartition (SGTB) (MD=−3.60%, 95%CI −5.89 to −1.31, P=0.002), mini-gastric bypass (MGB) (MD=−2.36%, 95%CI −4.13 to −0.58, P=0.009), duodenal-jejunal bypass liner (DJBL) (MD=−1.85%, 95%CI −2.75 to −1.96, P<0.000 01), sleeve gastrectomy (SG) (MD=−1.48%, 95%CI −2.49 to −0.47, P=0.004), and Roux-en-Y gastric bypass (RYGB) (MD=−1.31%, 95%CI −2.02 to −0.59, P=0.003). The effects of biliopancreatic diversion with duodenal switch and gastric plication were uncertain. Adjustable gastric banding and Roux-en-Y gastrojejunostomy had no significant effects on HbA1c. Because of the limitations of small sample size and high risk of bias, the results of SGTB requires further validation. ConclusionsThe current evidence suggests that the bariatric surgeries that have relatively beneficial effects for lowering HbA1c treatment are MGB, DJB, SG and RYGB in sequence.