Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials.

Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.

Optimal interval to surgery after chemoradiotherapy in rectal cancer: A protocol for systematic review and network meta-analysis.

BACKGROUND: Rectal cancer is the second leading cause of cancer-related death in the Western world. Preoperative neoadjuvant chemoradiotherapy (nCRT) has been widely performed in the treatment of rectal cancer patients. However, there is no consensus on the length of waiting interval between the end of preoperative nCRT and surgery. Present network meta-analysis (NMA) aims to compare the differences of effect between all available interval to surgery after nCRT in rectal cancer in improving overall survival, disease-free survival and pathologic complete response (pCR) rate, and to rate the certainty of evidence from present NMA. METHOD: We will systematically search PubMed, EMBASE, Chinese Biomedical Literature Database, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies assessing the interval to surgery after CRT in rectal cancer. We will conduct this systematic review and meta-analysis using Bayesian method and report the full-text according to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Extension Vision statement (PRISMA-NMA). We will assess the risk of bias of individual study using the Newcastle-Ottawa Scale and Cochrane Handbook V.5.1.0. We will also use the advance of GRADE to rate the certainty of NMA. Data will be analyzed by using R software V.3.4.1. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: To the best of our knowledge, this systematic review and NMA will first use both direct and indirect evidence to compare the differences of all available interval to surgery after CRT in rectal cancer. This is a protocol of systematic review and meta-analysis, so the ethical approval and patient consent are not required.