Accuracy of the Childhood Autism Rating Scale: a systematic review and meta-analysis.

AIM: To assess the accuracy of the Childhood Autism Rating Scale (CARS) through systematic review and meta-analysis. METHOD: Studies that provided quantitative values for the reliability and validity for all versions of CARS were searched through MEDLINE, CINAHL, PsycINFO, Embase, and OpenDissertations. RESULTS: A total of 24 studies with 4433 participants were included in our analysis. Meta-analysis showed that the summary Cronbach's alpha regarding a team of physicians and psychologists or others subgroup, derived from six studies (952 participants), was considered to be acceptable at 0.90 (95% confidence interval, 0.87-0.92) with moderate heterogeneity. Analysis of two 'low risk of bias' studies on the criterion validity for CARS with a cut-off of 30 and DSM-IV resulted in sensitivity of 0.86 and 0.71 and specificity of 0.79 and 0.75. INTERPRETATION: Through the results of the current systematic review and meta-analysis, the internal consistency can be considered to be acceptable for a team of physicians and psychologists or others subgroup. In terms of the criterion validity, the sensitivity was thought to be acceptable although the specificity was not, suggesting that CARS should be used along with other confirmatory tools. WHAT THIS PAPER ADDS: The Childhood Autism Rating Scale can be considered as a supplementary diagnostic tool for autism spectrum disorder.

EXACTITUD DE LA ESCALA DE CALIFICACIÓN DE AUTISMO INFANTIL (CARS): UNA REVISIÓN SISTEMÁTICA Y METAANÁLISIS: OBJETIVO: Se evalúa la exactitud de la Escala de Calificación de Autismo Infantil (CARS) a través de revisión sistemática y metaanálisis. MÉTODO: Los estudios que proporcionaron valores cuantitativos para la confiabilidad y validez de todas las versiones de CARS fueron buscados a través de MEDLINE, CINAHL, PsycINFO, Embase y Open Dissertations. RESULTADOS: En nuestro análisis se incluyeron un total de 24 estudios con 4433 participantes. El metaanálisis mostró el resumen del alfa de Cronbach basado en datos de equipos de médicos y psicólogos u otros subgrupos, derivado de seis estudios (952 participantes), fue considerado aceptable en 0,90 (intervalo de confianza del 95%, 0,87 - 0,92) con moderada heterogeneidad. El análisis de dos estudios de «bajo riesgo de sesgo¼ sobre los criterios de validez para CARS con un corte de 30 y criterios de DSM-IV, mostró una sensibilidad de 0,86 y 0,71 y especificidad de 0,79 y 0,75. INTERPRETACIÓN: Los resultados de la revisión sistemática actual y el metaanálisis demostró que la consistencia interna de CARS puede considerarse aceptable cuando es utilizado por equipos de médicos y psicólogos u otros subgrupos. En cuanto a la validez de criterio, se considero que la sensibilidad era aceptable, aunque la especificidad no lo es, sugiriendo que CARS debería utilizarse junto con otras herramientas confirmatorias.

ACURÁCIA DA ESCALA DE PONTUAÇÃO DO AUTISMO NA INFÂNCIA (CHILDHOOD AUTISM RATING SCALE -CARS): UMA REVISÃO SISTEMÁTICA E METANÁLISE: OBJETIVO: Avaliar a acurácia da Escala de Pontuação do Autismo na Infância (Childhood Autism Rating Scale -CARS) por meio de revisão sistemática e metanálise. MÉTODO: Estudos que forneceram valores de confiabilidade e validade de todas as versões da CARS foram pesquisados por meio das bases MEDLINE, CINAHL, PsycINFO, Embase, e OpenDissertations. RESULTADOS: Um total de 24 estudos com 4433 participantes foram incluídos em nossa análise. A metanálise mostrou que o resumo do alfa de Cronbach para uma equipe de médicos e psicólogos ou outros subgrupos, derivado de seis estudos (952 participantes), foi considerado aceitável a 0,90 (intervalo de confiança a 95%, 0,87-0,92) com heterogeneidade moderada. Análise de dois estudos com "baixo risco de viés" sobre a validade de critério da CARS com valor de corte de 30 e DSM-IV resultou em sensibilidade de 0,86 e 0,71 e especificidade de 0,79 and 0,75. INTERPRETAÇÃO: Por meio dos resultados da presente revisão sistemática e metanálise, a consistência interna pode ser considerada aceitável para uma equipe de médicos e psicólogos ou outros subgrupos. Em termos de validade de critério, a sensibilidade foi considerada aceitável, embora a especificidade não tenha sido, sugerindo que a CARS deva ser usada juntamente com outros instrumentos confirmatórios.

Association of fracture risk with benzodiazepine among adults in South Korea.

This study examined the association between fracture and benzodiazepine (BZD) prescription in Korean adults using case-crossover (CCO) and self-controlled case-series (SCCS) designs, which have the advantage to control confounding bias, such as individual characteristics. Patients with fracture were defined as patients who visited the emergency room and orthopedics department with the ICD-10 diagnosis code for fracture. Fractures due to motor vehicle accidents and stroke were excluded. Whereas the CCO design presented odds ratio (OR) using a conditional logistic regression model, SCCS design showed incidence rate ratio (IRR) using a conditional Poisson regression model. The concomitant drugs that can affect the fracture were adjusted. Sensitivity analysis and subgroup analysis by age (elderly vs. nonelderly), action mechanism (short-acting vs. long-acting), and prescription duration (short-term user vs. long-term user) were conducted. The adjusted OR (AOR) for control period I (prior to 90 days from case) was 1.39 (95% CI=1.25-1.54) for all BZD prescriptions. The adjusted ORs for other control periods showed similar trends. The adjusted IRRs (AIRR) during the first 4 weeks, 4-8 weeks, 8-12 weeks, and 12-16 weeks from new BZD use were 1.46 (95% CI=1.28-1.66), 1.23 (95% CI=1.01-1.49), 1.09 (95% CI=0.86-1.37), and 1.38 (95% CI=1.07-1.77), respectively. Regardless of age group, action mechanism, or prescription duration, fracture risk was higher during case period than control. The risk for fracture was higher in both elderly and non-elderly people with BZD prescription than in those without BZD prescription. Careful monitoring for people who start BZD treatment and further research in the non-elderly is required.

In-depth investigation for prescribing trends of benzodiazepines in South Korea.

This study aimed to investigate national prescription trends of benzodiazepines (BZD) for adults between 2007 and 2011 using Health Insurance Review and Assessment Service (HIRA) database in South Korea. Data analysis was performed by claim unit or patient unit. For the analysis of patient unit, each claim was merged by the same patient. Defined daily dose (DDD) was used to analyze the data in terms of dose and periods of BZD prescription. We identified a total of 22,361,449 adult patients who had BZD prescription at least once in 1,989,263 claims during 5 years. The average national BZD prescription prevalence for 1 year was 23.7%, 7.9%, 4.7%, and 3.2% of >= 1 day supply, >= 30 days supply, >= 90 days supply, and >= 180 days supply, respectively. The trends for 5 years were very similar. Among study population, 87.7% visited only non-psychiatric departments and the most frequent indication was gastrointestinal related diseases. BZD consumption expressed as DDDs per 1,000 inhabitants per day was 109.2. BZD consumption tended to be ~ 4 x higher in elderly than that of non-elderly (268.6 vs. 60.0 in male and 367.7 vs. 90.9 in female). Our study indicated the possibilities for inappropriate prescription of BZD, and the limitation policy on continuous prescription over 30 days supply did not seem to be effective. The effective interventions including an educational program for appropriate prescription of BZD should be considered.

Endovascular coiling versus neurosurgical clipping in patients with unruptured intracranial aneurysm: a systematic review.

BACKGROUND: To compare the effects of endovascular coiling and neurosurgical clipping in patients with unruptured intracranial aneurysm. METHODS: Sixteen electronic databases were searched for articles published between 1950 and July 2010 to compare clinical outcomes of clipping and coiling. Researchers reviewed all searched articles and extracted data independently. The quality of studies and evidence were evaluated using MINORS and GRADEprofiler, respectively. The odds ratio (OR) was calculated using the inverse variance meta-analysis method for each study outcome. To assess heterogeneity of ORs across cohorts, Cochran's Q statistic and I² were used. RESULTS: Of 4160 studies, 24 were identified (n = 31865). Clipping resulted in significantly higher disability using the Glasgow Outcome Scale (OR, 2.38; 95% CI, 1.33-4.26) and Modified Rankin Scale (OR, 2.83; 95% CI, 1.42-5.63) when compared with coiling. ORs for complications were also higher with clipping (ORs for neurological and cardiac complications were 1.94 with a 95% confidence interval [CI] of 1.09-3.47 and 2.51 with a 95% CI of 1.15-5.50). Clipping resulted in significantly greater disability in the short term (≤6 m)(OR on the Glasgow Outcome Scale, 2.72; 95% CI, 1.16-6.34), but not in the long term (>6 m)(OR for Glasgow Outcome Scale, 2.12; 95% CI, 0.93-4.84). CONCLUSIONS: Coiling was a better procedure for treatment of unruptured intracranial aneurysm in terms of disability, complications, especially in the short term. Because of the limitations of the reviewed studies, further studies are required to support the present results.

Improving Glycemic Control in Type 2 Diabetes Using Mobile Applications and e-Coaching: A Mixed Treatment Comparison Network Meta-Analysis.

OBJECTIVES: This study compared the effectiveness of glycemic control among usual care, care management using a mobile application (app), and management using an app with additional e-coaching for patients with type 2 diabetes mellitus (T2DM) using a mixed treatment comparison (MTC) network meta-analysis (NMA). METHODS: A systematic search for published randomized controlled trials (RCTs) was conducted, which included Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, CINAL, Koreamed, KMbase, and ScienceOn, until October 2020. Among the 10,391 studies identified after removing duplicates, 14 RCTs were finally included in the MTC NMA. Data extraction and methodological quality assessment using version 2 of the Cochrane tool for assessing the risk-of-bias in randomized trials (RoB 2) was performed. The comparative efficacy was analyzed using the random-effects NMA based on a frequentist model by the intervention group and main outcome variables. RESULTS: At the 3-month follow-up after each intervention, a comparison of the P-scores revealed the app plus e-coaching intervention to be the most effective method for reducing the HbA1c level in a homogeneous gender ratio group (P-score 0.92). At the 6-month follow-up period, app intervention was the best in reducing the HbA1c level in the homogeneous gender ratio and under 60 years of age group (P-score 1.00). CONCLUSIONS: Based on MTC analysis using the data from published RCTs, mobile apps or apps with e-coaching interventions for T2DM patients were more effective in improving the HbA1c values, FBS, and hypoglycemia frequency than usual care. Nevertheless, further research will be needed to clarify the effects of adding e-coaching to the app. STUDY REGISTRATION: Research Registry UIN (reviewregistry780).

Correction: Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8.

[This corrects the article DOI: 10.1371/journal.pone.0187139.].

Psychometric Properties of the Internet Addiction Test: A Systematic Review and Meta-Analysis.

This article performs a systemic review of psychometric properties of Internet Addiction Test (IAT)-the most widely used tool for assessing Internet addiction in clinic and research field. Studies measuring psychometric properties of IAT (original version) were searched through MEDLINE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Embase. A total of 25 studies including 18,421 subjects were reviewed in our study. Based on meta-analysis for internal consistency, the pooled Cronbach's alpha coefficient from college/university students with a single department subgroup was 0.90 (95percent confidence interval [CI], 0.89-0.91), and that from middle-/high-school students (older than 15 years) subgroup was 0.93 (95 percent CI, 0.92-0.93). According to test-retest analysis, the pooled Spearman's correlation coefficient from college/university students with a single department subgroup was high at 0.83 (95 percent CI, 0.81-0.85), along with low publication bias. Convergent validity showed correlation coefficients of 0.62-0.84, as compared with major tools. For construct validity, the number of factors is believed to be 1-2, only considering studies that followed the guidelines. IAT appears to have acceptable internal consistency, test-retest reliability, and convergent validity in specific groups. To verify these values, well-designed evidence-based studies assessing psychometric properties of IAT across diverse populations are warranted.

Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8.

BACKGROUND: This systematic review examined the reliability and validity of the Morisky Medication Adherence Scale-8 (MMAS-8), which has been widely used to assess patient medication adherence in clinical research and medical practice. METHODS: Of 418 studies identified through searching 4 electronic databases, we finally analyzed 28 studies meeting the selection criteria of this study regarding the reliability and validity of MMAS-8 including sensitivity and specificity. Meta-analysis for Cronbach's α, intraclass correlation coefficient (ICC), sensitivity and specificity to detect a patient with nonadherence to medication were performed. The pooled estimates for Cronbach's α and ICC were calculated using the random-effects weighted T transformation. A bivariate random-effects model was used to estimate pooled sensitivity and specificity. FINDINGS: The pooled Cronbach's α estimate for type 2 diabetes group in 7 studies and osteoporosis group in 3 studies were 0.67 (95% Confidence Interval(CI), 0.65 to 0.69) and 0.77 (95% CI, 0.72 to 0.83), respectively. With regard to test-retest, the pooled ICC for type 2 diabetes group in 3 studies and osteoporosis group in 2 studies were 0.81 (95% CI, 0.75 to 0.85) and 0.80 (95% CI, 0.74 to 0.85). For a cut-off value of 6, the pooled sensitivity and specificity in 12 studies were 0.43 (95% CI, 0.33 to 0.53) and 0.73 (95% CI, 0.68 to 0.78), respectively. CONCLUSIONS: The MMAS-8 had acceptable internal consistency and reproducibility in a few diseases like type 2 diabetes. Using the cut-off value of 6, criterion validity was not enough good to validly screen a patient with nonadherence to medication. However, this study did not calculated a pooled estimate for criterion validity using the higher values than 6 as a cut-off value since most of included individual studies did not report criterion validity based on those values.

Survival outcomes after whole brain radiation therapy and/or stereotactic radiosurgery for cancer patients with metastatic brain tumors in Korea: a systematic review.

AIM: To compare survival outcomes after whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and WBRT plus SRS combination therapy in Korea, by performing a quantitative systematic review. MATERIALS AND METHODS: We searched 10 electronic databases for reports on Korean patients treated with WBRT or SRS for brain metastases published prior to July 2010. Independent reviewers screened all articles and extracted the data. When a Kaplan-Meier survival curve was available, median survival time and standard errors were calculated. Summary estimates for the outcomes in each study were calculated using the inverse variance random-effects method. RESULTS: Among a total of 2,761 studies, 20 studies with Korean patients (n=1,053) were identified. A combination of 12 studies (n=566) with WBRT outcomes showed a median survival time of 6.0 months (95%CI: 5.9-6.2), an overall survival rate of 5.6% (95%CI: 1-24), and a 6-month survival rate of 46.5% (95%CI: 37.2-56.1). For nine studies (n=412) on SRS, the median survival was 7.9 months (95%CI: 5.1-10.8), and the 6-month survival rate was 63.1% (95%CI: 49.8-74.8). In six studies (n=75) using WBRT plus SRS, the median survival was 10.7 months (95%CI: 4.7-16.6), and the overall and 6-month survival rates were 16.8% (95%CI: 6.2-38.2) and 85.7% (95%CI: 28.3-96.9), respectively. CONCLUSIONS: WBRT plus SRS showed better 1-year survival outcome than of WBRT alone for Korean patients with metastatic brain tumors. However, the results of this analysis have to be interpreted cautiously, because the risk factors of patients were not adjusted in the included studies.

Trends in the incidence of subarachnoid hemorrhage in South Korea from 2006-2009: an ecological study.

OBJECTIVE: The purpose of this study is to investigate trends in the incidence of subarachnoid hemorrhage (SAH) in South Korea from 2006-2009. METHODS: We used the national health claim database managed by Health Insurance Review and Assessment Service, which contains all hospital records of every Korean citizen. Patients with SAH were defined as International Classification of Diseases-10 codes with a hospitalization period of ≥ 14 days or death within 14 days of hospitalization. We evaluated trends in the incidence of SAH during a 4-year period using the Cochran-Armitage trend test. RESULTS: We identified 35,263 patients with SAH among adult patients (≥ 18 years old) from 2005-2009. Age-adjusted SAH incidence rates decreased from 13.4 in 2006 to 12.4 in 2009/100,000 men (P = 0.0025) and women also showed a decrease from 19.4-17.3/100,000 (P < 0.0001). However, this decreasing pattern was not shown in patients less than 50 years of age. SAH incidence showed gender differences dependent on age; men who were 40 years old or less had a higher incidence than women. CONCLUSIONS: The age-adjusted incidence rates of SAH were slightly decreased in South Korea. Further research should be conducted to identify the clinical risk factors to reduce SAH incidence rates even more, especially in younger people.

Rupture rate for patients with untreated unruptured intracranial aneurysms in South Korea during 2006-2009.

OBJECT: The authors investigated the rupture rate among patients with untreated unruptured intracranial aneurysms (UIAs) in South Korea during 2006-2009. METHODS: A longitudinal study using national representative health-claim data, including all hospital records for every Korean citizen, was used. Patients with a UIA who were 18-80 years old in 2006 were identified using the I67.1 ICD-10 code. To select eligible patients, a historical period of 1 year prior to the first diagnosis of a UIA in 2006 was utilized. Patients with a previous UIA diagnosis, subarachnoid hemorrhage (SAH), or treatments, such as clipping or coiling, during the historical period were excluded from analysis. Patients with head trauma or a brain tumor during the historical period were also excluded. Eligible patients were followed up for at least 3 years from the index date. Rupture was defined as SAH events with at least 14 days of hospitalization, using the I60 ICD-10 code and excluding the I60.8 code, or death within 14 days of hospitalization. RESULTS: Seven thousand four hundred four patients with UIAs were identified, including 1441 treated patients (20%) and 5963 untreated patients (80%), with a median follow-up of 3.3 years. Rupture events occurred in 163 (0.9 cases/100 person-years) of the 5963 untreated patients. The rupture rate was highest in the 1st year after UIA diagnosis. An older age was a risk factor for rupture among patients with UIAs. CONCLUSIONS: The overview of the incidence of rupture indicates the need for a preventive strategy and future studies to prevent rupture in Asian patients with UIAs.