Characteristics and methods of incorporating randomized and nonrandomized evidence in network meta-analyses: a scoping review.

OBJECTIVES: The objective of the study was to conduct a scoping review of the published literature on methods used to combine randomized and nonrandomized evidence (NRE) in network meta-analyses (NMAs) and their respective characteristics. STUDY DESIGN AND SETTING: We conducted a scoping review using a list of NMAs which incorporated NRE that were identified from a previous review. All NMAs that included NRE in the analysis of main outcomes or sensitivity analyses were eligible for inclusion. Two reviewers independently screened studies for inclusion and performed data abstraction. Data analysis involved quantitative (frequencies and percentages) and qualitative (narrative synthesis) methods. RESULTS: A total of 23 NMAs met the predefined inclusion criteria, of which 74% (n = 17) used naïve pooling, 0% used NRE as informative priors, 9% (n = 2) used the 3-level Bayesian hierarchical model, 9% (n = 2) used all methods, and 9% (n = 2) used other methods. Most NMAs were supplemented with additional analyses to investigate the effect estimates when only randomized evidence was included. CONCLUSION: Although most studies provided justification for the inclusion of NRE, transparent reporting of the method used to combine randomized evidence and NRE was unclear in most published networks. Most NMAs used naïve pooling for combining randomized evidence and NRE.

Effects of a specially designed aerobic dance routine on mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) is known as a transitional stage or phase between normal aging and dementia. In addition, it is associated with an increased risk of dementia. Research has shown that moderate-intensity exercise is associated with a decreased risk of cognitive impairment. Two recent studies demonstrated that dance interventions are associated with improved cognitive function in the elderly with MCI. PURPOSE: We evaluated the effect of a moderate-intensity aerobic dance routine on the cognitive function in patients with MCI. PATIENTS AND METHODS: This is a single-blind randomized controlled trial. Sixty MCI patients were randomized to receive either treatment (aerobic dance routine + usual care) or control (usual care only) for 3 months. All patients received usual care for an additional 3 months thereafter. The aerobic dance routine was a specially designed dance routine which involved cognitive effort for patients to memorize the complex movements. Wechsler memory scale-revised logical memory (WMS-R LM) and event-related evoked potentials (ERPs) P300 latency were used to assess patients' cognitive function at baseline, 3 months, and 6 months. RESULTS: Twenty-nine patients received exercise therapy and 31 patients received usual care. Patients in the treatment group showed a greater improvement in memory (difference in WMS-R LM changes over 3 months 4.6; 95% CI 2.2, 7.0; p<0.001) and processing speed (difference in P300 latency changes over 6 months -20.0; 95% CI=-39.5, -0.4; p<0.05) compared to control. CONCLUSION: This dance routine improves cognitive function, especially episodic memory and processing speed, in MCI patients and merits promotion in communities.

Clinicopathological characteristics of oestrogen receptor negative, progesterone receptor positive breast cancers: re-evaluating subsets within this group.

AIMS: The presence of oestrogen and progesterone receptors (ER, PR) in breast carcinoma is an important prognostic indicator as well as a predictor of likely response to hormonal treatment. Current ambiguity surrounds ER-negative (-)/PR-positive (+) breast cancer (BC) as to whether this phenotype exists as a distinct entity. The independent predictive value of PR for treatment considerations is also in question, as some investigators believe ER status to be the single most important therapeutic predictive factor in BC. We undertook this study to determine the existence of ER(-)/PR(+) BC and the prognostic effect, if any, of this phenotype. METHODS: We investigated 267 archival documented ER(-)/PR(+) BCs diagnosed between January 1994 and July 2009. Histological slides were retrieved and reviewed. Tissue microarrays were constructed by selecting two 1 mm cores of tumour per case. Repeat immunohistochemistry was performed for confirmation of the ER(-)/PR(+) status. Clinicopathological parameters including age, ethnicity, tumour size, histological grade, histological subtype, associated ductal carcinoma in situ, lymphovascular invasion and lymph node status were evaluated. RESULTS: On repeat immunohistochemistry, 92 tumours were confirmed as ER(-)/PR(+) BCs. This phenotype accounted for 1.1% of all BC phenotypes and exhibited different clinicopathological features and survival outcome when compared with other phenotypes. ER(-)/PR(+) tumours showed a trend for an early recurrence and poorer overall survival as compared with the patients with ER(+)/PR(+) tumours and similar to ER(-)/PR(-) tumours. CONCLUSIONS: Our findings suggest that ER(-)/PR(+) BCs exist, although rare, with distinct pathological and clinical characteristics from patients with ER(+)/PR(+) BCs.