TY - JOUR A1 - Menger, Johannes A1 - Lee, Zheng-Yii A1 - Notz, Quirin A1 - Wallqvist, Julia A1 - Hasan, M. Shahnaz A1 - Elke, Gunnar A1 - Dworschak, Martin A1 - Meybohm, Patrick A1 - Heyland, Daren K. A1 - Stoppe, Christian T1 - Administration of vitamin D and its metabolites in critically ill adult patients: an updated systematic review with meta-analysis of randomized controlled trials JF - Critical Care N2 - Background The clinical significance of vitamin D administration in critically ill patients remains inconclusive. The purpose of this systematic review with meta-analysis was to investigate the effect of vitamin D and its metabolites on major clinical outcomes in critically ill patients, including a subgroup analysis based on vitamin D status and route of vitamin D administration. Methods Major databases were searched through February 9, 2022. Randomized controlled trials of adult critically ill patients with an intervention group receiving vitamin D or its metabolites were included. Random-effect meta-analyses were performed to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Risk of bias assessment included the Cochrane tool for assessing risk of bias in randomized trials. Results Sixteen randomized clinical trials with 2449 patients were included. Vitamin D administration was associated with lower overall mortality (16 studies: risk ratio 0.78, 95% confidence interval 0.62–0.97, p = 0.03; I2 = 30%), reduced intensive care unit length of stay (12 studies: mean difference − 3.13 days, 95% CI − 5.36 to − 0.89, n = 1250, p = 0.006; I2 = 70%), and shorter duration of mechanical ventilation (9 studies: mean difference − 5.07 days, 95% CI − 7.42 to − 2.73, n = 572, p < 0.0001; I2 = 54%). Parenteral administration was associated with a greater effect on overall mortality than enteral administration (test of subgroup differences, p = 0.04), whereas studies of parenteral subgroups had lower quality. There were no subgroup differences based on baseline vitamin D levels. Conclusions Vitamin D supplementation in critically ill patients may reduce mortality. Parenteral administration might be associated with a greater impact on mortality. Heterogeneity and assessed certainty among the studies limits the generalizability of the results. KW - critically ill KW - vitamin D KW - nutrition KW - meta-analysis KW - mortality KW - mechanical ventilator weaning Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299700 VL - 26 IS - 1 ER - TY - JOUR A1 - Hackenbroich, Samantha A1 - Kranke, Peter A1 - Meybohm, Patrick A1 - Weibel, Stephanie T1 - Include or not to include conference abstracts in systematic reviews? Lessons learned from a large Cochrane network meta-analysis including 585 trials JF - Systematic Reviews N2 - Background Systematic reviews attempt to gather all available evidence. Controversy exists regarding effort and benefit of including study results presented at conferences only. We recently published a Cochrane network meta-analysis (NMA) including 585 randomized controlled trials comparing drugs for prevention of postoperative nausea and vomiting (PONV). Studies published as conference abstracts only were excluded. This study aimed to include all eligible studies published as abstracts only, assessing their added value regarding reporting quality and effect on the review’s interpretation. Methods Conference abstracts were searched in the review’s excluded studies and conference proceedings of anaesthesiologic societies. We assessed their reporting quality regarding review’s eligibility criteria, Cochrane ‘risk of bias’ assessment tool 1.0, and adherence to CONSORT (Consolidated Standards of Reporting Trials) for abstracts. Abstracts were included in sensitivity NMA, and impact on the NMA structure was investigated. Results We identified 90 abstracts. A total of 14% (13/90) were eligible. A total of 86% (77/90) are awaiting classification due to insufficient reporting of review’s eligibility criteria. In abstracts awaiting classification, sufficient information was missing on standardization of anaesthesia in 71% (55/77), age of participants in 56% (43/77), and outcome details in 46% (36/77). A total of 73% (66/90) of abstracts lacked sufficient information on 15/25 data extraction items. Reported study characteristics of abstracts were comparable to included studies of the review. A total of 62% (56/90) of abstract trials were assessed as overall high risk of bias due to poor reporting. Median adherence to CONSORT for abstracts was 24% (IQR, 18 to 29%). Six of the 13 eligible abstracts reported relevant outcome data in sufficient detail for NMA on seven outcomes of the Cochrane review. Inclusion of abstracts did not substantially change the network structure, network effect estimates, ranking of treatments, or the conclusion. Certainty of evidence for headache on palonosetron use was upgraded from very low to low. Conclusions Most conference abstracts on PONV were insufficiently reported regarding review’s narrow inclusion criteria and could not be included in NMA. The resource-intensive search and evaluation of abstracts did not substantially extent the full-text evidence base of the review, given the few adequately reported abstracts. Conferences should oblige authors to adhere to CONSORT for abstracts. KW - systemic reviews KW - conference abstracts KW - meta-analysis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-299660 VL - 11 IS - 1 ER - TY - JOUR A1 - Hendricks, Anne A1 - Müller, Sophie A1 - Fassnacht, Martin A1 - Germer, Christoph-Thomas A1 - Wiegering, Verena A. A1 - Wiegering, Armin A1 - Reibetanz, Joachim T1 - Impact of lymphadenectomy on the oncologic outcome of patients with adrenocortical carcinoma — a systematic review and meta-analysis JF - Cancers N2 - (1) Background: Locoregional lymphadenectomy (LND) in adrenocortical carcinoma (ACC) may impact oncological outcome, but the findings from individual studies are conflicting. The aim of this systematic review and meta-analysis was to determine the oncological value of LND in ACC by summarizing the available literature. (2) Methods: A systematic search on studies published until December 2020 was performed according to the PRISMA statement. The primary outcome was the impact of lymphadenectomy on overall survival (OS). Two separate meta-analyses were performed for studies including patients with localized ACC (stage I–III) and those including all tumor stages (I–IV). Secondary endpoints included postoperative mortality and length of hospital stay (LOS). (3) Results: 11 publications were identified for inclusion. All studies were retrospective studies, published between 2001–2020, and 5 were included in the meta-analysis. Three studies (N = 807 patients) reported the impact of LND on disease-specific survival in patients with stage I–III ACC and revealed a survival benefit of LND (hazard ratio (HR) = 0.42, 95% confidence interval (95% CI): 0.26–0.68). Based on results of studies including patients with ACC stage I–IV (2 studies, N = 3934 patients), LND was not associated with a survival benefit (HR = 1.00, 95% CI: 0.70–1.42). None of the included studies showed an association between LND and postoperative mortality or LOS. (4) Conclusion: Locoregional lymphadenectomy seems to offer an oncologic benefit in patients undergoing curative-intended surgery for localized ACC (stage I–III). KW - adrenocortical carcinoma KW - adrenal cancer KW - lymphadenectomy KW - lymph node dissection KW - LND KW - LNE KW - review KW - meta-analysis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254798 SN - 2072-6694 VL - 14 IS - 2 ER - TY - JOUR A1 - Müller, Sophie A1 - Köhler, Franziska A1 - Hendricks, Anne A1 - Kastner, Carolin A1 - Börner, Kevin A1 - Diers, Johannes A1 - Lock, Johan F. A1 - Petritsch, Bernhard A1 - Germer, Christoph-Thomas A1 - Wiegering, Armin T1 - Brain metastases from colorectal cancer: a systematic review of the literature and meta-analysis to establish a guideline for daily treatment JF - Cancers N2 - Colorectal cancer (CRC) is the third most common malignancy worldwide. Most patients with metastatic CRC develop liver or lung metastases, while a minority suffer from brain metastases. There is little information available regarding the presentation, treatment, and overall survival of brain metastases (BM) from CRC. This systematic review and meta-analysis includes data collected from three major databases (PubMed, Cochrane, and Embase) based on the key words “brain”, “metastas*”, “tumor”, “colorectal”, “cancer”, and “malignancy”. In total, 1318 articles were identified in the search and 86 studies matched the inclusion criteria. The incidence of BM varied between 0.1% and 11.5%. Most patients developed metastases at other sites prior to developing BM. Lung metastases and KRAS mutations were described as risk factors for additional BM. Patients with BM suffered from various symptoms, but up to 96.8% of BM patients were asymptomatic at the time of BM diagnosis. Median survival time ranged from 2 to 9.6 months, and overall survival (OS) increased up to 41.1 months in patients on a multimodal therapy regimen. Several factors including age, blood levels of carcinoembryonic antigen (CEA), multiple metastases sites, number of brain lesions, and presence of the KRAS mutation were predictors of OS. For BM diagnosis, MRI was considered to be state of the art. Treatment consisted of a combination of surgery, radiation, or systemic treatment. KW - brain metastases KW - cerebral metastases KW - BM KW - colorectal cancer KW - CRC KW - systematic review KW - meta-analysis Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228883 SN - 2072-6694 VL - 13 IS - 4 ER - TY - JOUR A1 - Buerger, Arne A1 - Vloet, Timo D. A1 - Haber, Lisa A1 - Geissler, Julia M. T1 - Third-wave interventions for eating disorders in adolescence - systematic review with meta-analysis JF - Borderline Personality Disorder and Emotion Dysregulation N2 - Context: Third-wave therapies have demonstrated efficacy as a treatment option for EDs in adulthood. Data on the suitability for EDs in adolescence are lacking. Objective: To estimate the efficacy of third-wave interventions to reduce ED symptoms in adolescents in randomized controlled trials (RCTs) and uncontrolled studies. Data sources: We systematically reviewed the databases PubMed (1976-January 2021), PsycINFO (1943-January 2021), and the Cochrane database (1995-January 2021) for English-language articles on third-wave therapies. References were screened for further publications of interest. Study selection: RCTs and pre-post studies without control group, comprising patients aged 11-21 years (mean age = 15.6 years) with an ED diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified) investigating the efficacy of third-wave psychological interventions were included. Efficacy had to be evaluated according to the Eating Disorder Examination or Eating Disorder Examination-Questionnaire, the Eating Disorder Inventory-2, the Eating Disorder Inventory-3, or the Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10. The outcome assessed in the meta-analysis was the EDE total score. Data extraction: Independent extraction of data by two authors according to a pre-specified data extraction sheet and quality indicators. Data synthesis: We identified 1000 studies after removal of duplicates, assessed the full texts of 48 articles for eligibility, and included 12 studies with a total of 487 participants (female 97.3%/male 2.6%) in the qualitative synthesis and seven studies in the meta-analysis. Articles predominantly reported uncontrolled pre-post trials of low quality, with only two published RCTs. Treatments focused strongly on dialectical behaviour therapy (n = 11). We found moderate effects of third-wave therapies on EDE total score interview/questionnaire for all EDs (d = - 0.67; z = - 5.53; CI95% = - 0.83 to - 0.59). Descriptively, the effects appeared to be stronger in patients with BN and BED. Conclusion: At this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence. Since almost all of the identified studies used DBT, it is unfortunately not possible to assess other third-wave treatments' efficacy. KW - DBT KW - adolescence KW - eating disorders KW - third-wave psychotherapy KW - meta-analysis KW - review Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260545 VL - 8 ER - TY - JOUR A1 - Vey, Johannes A1 - Kapsner, Lorenz A. A1 - Fuchs, Maximilian A1 - Unberath, Philipp A1 - Veronesi, Giulia A1 - Kunz, Meik T1 - A toolbox for functional analysis and the systematic identification of diagnostic and prognostic gene expression signatures combining meta-analysis and machine learning JF - Cancers N2 - The identification of biomarker signatures is important for cancer diagnosis and prognosis. However, the detection of clinical reliable signatures is influenced by limited data availability, which may restrict statistical power. Moreover, methods for integration of large sample cohorts and signature identification are limited. We present a step-by-step computational protocol for functional gene expression analysis and the identification of diagnostic and prognostic signatures by combining meta-analysis with machine learning and survival analysis. The novelty of the toolbox lies in its all-in-one functionality, generic design, and modularity. It is exemplified for lung cancer, including a comprehensive evaluation using different validation strategies. However, the protocol is not restricted to specific disease types and can therefore be used by a broad community. The accompanying R package vignette runs in ~1 h and describes the workflow in detail for use by researchers with limited bioinformatics training. KW - bioinformatics tool KW - R package KW - machine learning KW - meta-analysis KW - biomarker signature KW - gene expression analysis KW - survival analysis KW - functional analysis Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-193240 SN - 2072-6694 VL - 11 IS - 10 ER - TY - THES A1 - Dangl [geb. Stimmer], Magdalena T1 - Die Wirksamkeit von Schienentherapie und okklusalen Einschleifmaßnahmen unter Berücksichtigung des Chronifizierungsgrades Craniomandibulärer Dysfunktionen: Eine Systematische Übersichtsarbeit mit Metaanalyse T1 - The effectiveness of occlusal splints and adjustments with regard to the chronification process of temporomandibular disorders in adults: A systematic review and metaanalysis N2 - Hintergrund: Die fehlende Diagnostik des patientInnenindividuellen CMD-Schmerzchronifizierungsgrades könnte Grund für die Heterogenität der Studienergebnisse zur Effektivität von Schienentherapie und okklusalen Einschleifmaßnahmen sein. Ziele: Dieser Systematische Review mit Metaanalyse hat als Ziel, die Effektivität von Schienentherapie und okklusalen Einschleifmaßnahmen bei der Behandlung von CMD unter besonderer Berücksichtigung des Grades der Schmerzchronifizierung zu untersuchen. Literaturquellen: Die Datenbanken Pubmed/MEDLINE, EMBASE, Cochrane Library, Livivo, OpenGrey, drks.de, Clinicaltrials.gov., sowie zusätzliche nicht gelistete Literatur wurden hierzu durchsucht. Auswahlkriterien: Analysiert wurden randomisierte klinische Studien, welche erwachsene PatientInnen mit einer schmerzhaften CMD untersuchten, die mit einer Okklusionsschiene oder okklusalen Einschleifmaßnahmen in jeglicher Kombination behandelt wurden. Die Studien wurden nach Hinweisen untersucht, die vermuten ließen, dass die ProbandInnen unter einer chronifizierten dysfunktionalen CMD Schmerzen litten. Anschließend wurde die Effektivität der Interventionen im Hinblick auf den erfassten bzw. vermuteten Chronifizierungsgrad differenziert betrachtet. Die Effektivität wurde bzgl. der folgenden Messparameter untersucht: aktuelle Schmerzintensität in Ruhe, maximal aktive Kieferöffnungskapazität, Kiefergelenkgeräusche, Palpationsschmerzen aus der Kaumuskulatur, Depressivität und somatoforme Beschwerden. Studienbewertung: Nachdem die eingeschlossenen Studien ausgewertet, in ihrer Qualität bewertet (Risk of Bias-Tool des Cochrane-Instituts) und die Daten extrahiert worden waren, wurde eine Metaanalyse mithilfe des Review Managers (RevMan 5.3) des Cochrane Instituts durchgeführt. Ergebnisse: ProbandInnen mit funktionalen Schmerzen nach den hier definierten Kriterien erfuhren bis zu 6 Monate nach Behandlungsbeginn eine statistisch signifikant stärkere Schmerzreduktion (p<0,00001) sowie niedrigere Werte der somatoformen Beschwerden (p=0,01) und Depression-Scores (p=0,002) als Probanden mit dysfunktionalen Schmerzen. Dagegen verbesserte sich die Kieferöffnungskapazität in dieser Subgruppe nicht statistisch signifikant mehr (p=0,40). Im kurzfristigen Zeitraum von bis zu 6 Monaten konnte die Okklusionsschiene verglichen mit einer Placebo-Schiene stärker CMD-Schmerzen senken (p=0,0002), wohingegen der Effektivitätsunterschied der Messparameter Kieferöffnungskapazität und Kiefergelenkgeräusche nicht statistisch signifikant war. Im Vergleich zu keiner Behandlung war die Okklusionsschiene im Zeitraum bis zu 6 Monaten statistisch signifikant effektiver in der Schmerzreduktion (p<0,00001); 6 bis 12 Monate nach Behandlungsbeginn war keine signifikant bessere Effektivität in der Schmerzreduktion zu verzeichnen (p=0,07). Die maximale Kieferöffnungskapazität zeigte in diesem Vergleich kein statistisch signifikantes Ergebnis im kurzfristigen Zeitraum. Die Schmerzreduktion im kurzfristigen Zeitraum ähnelte derer anderer aktiver Interventionen. Als Kointervention bringt die Schienentherapie in keinem der untersuchten Endpunkte und Zeiträume einen statistisch signifikanten Mehrwert mit sich. Eine erhöhte Vertikaldimension könnte die Effektivität der Okklusionsschiene verbessern. Ansonsten ist die Effektivität unterschiedlicher Okklusionsschienen vergleichbar, unter Berücksichtigung folgender Beobachtungen: eine ARS senkt die Schmerzen einer arthrogenen CMD (p=0,001) und eine Stabilisierungsschiene die Schmerzen einer myogenen oder gemischten CMD (p<0,00001) effektiver als keine Behandlung. Intraorale Adjustierungen eine Verbesserung der Schmerzsymptomatik erzielen (p=0,01). Die langfristige Effektivität der Interventionen konnte aufgrund der geringen Datenlage nicht ausreichend untersucht werden. Registrierungsnummer der Review bei PROSPERO: CRD42019123169. N2 - Background: The lack of diagnosis of patient specific pain chronicity in TMDs could be the reason for the heterogeneity of the study results on the effectiveness of occlusal splint therapy and occlusal adjustment measures. Objectives: This systematic review with meta-analysis was done to investigate the effectiveness of occlusal splint therapy and occlusal adjustment in the treatment of TMDs with respect to the degree of pain chronicity. Literature sources: The following databases were searched: Pubmed/MEDLINE, EMBASE, Cochrane Library, Livivo, OpenGrey, drks.de, Clinicaltrials.gov. as well as additional hand search in relevant literature. Criteria for the selection of suitable studies: All randomized clinical trials with adult participants with painful TMD, treated with an occlusal splint or occlusal adjustment in any combination were considered. The studies were then examined for factors presumably associated with chronic TMD in the sense of pain dysfunction. Subsequently, the effectiveness of the interventions was examined in a differentiated manner with regard to the assigned degree of pain chronicity. The effectiveness was examined in terms of the following outcomes: current pain intensity, maximum jaw opening capacity, temporomandibular joint (TMJ) sounds, pain on palpation from the masticatory muscles and the TMJs, depression and somatoform complaints. Study assessment: All included studies were evaluated regarding their quality (with the Risk of Bias tool of the Cochrane Collaboration). We extracted the data for the systematic review, and conducted a meta-analysis using the Review Manager (RevMan 5.3) of the Cochrane Collaboration. Results: Patients with functional orofacial pain according to the criteria defined here experienced a statistically significant higher pain reduction (p<0.00001) and lower values of somatoform pain (p=0.01) and depression (p=0.002) in the short-term period of up to 6 months after treatment than subjects with dysfunctional orofacial pain. In contrast, mouth opening restrictions in this subgroup did not improve significantly more (p=0.40). Over the short term, the occlusal splint was significantly more effective in reducing TMD pain than a placebo splint (p=0.0002), whereas the difference in effect between the endpoints maximum mouth opening capacity and TMJ sounds was not statistically significant. Compared to no treatment, the occlusal splint was significantly more effective in reducing pain in the short term (p<0.00001), while the effect was no longer statistically significant in the medium term (6 to 12 months after treatment). Based on mostly patients with functional pain, the maximum mouth opening capacity showed no statistically significant difference in this comparison in terms of the short-term period (p=0.28). Pain reduction in the short-term period was similarly effective compared to other active interventions (p=0.22). As a co-intervention, splint therapy did not show a statistically significant benefit in any of the endpoints and time periods investigated. An increased vertical dimension might improve the effectiveness of the occlusal splint. Otherwise the effectiveness of different occlusal splints is roughly comparable, as long as it is considered that an ARS treats arthrogenic TMD pain (p=0.001) and a stabilizing splint treats the pain of a CMD of myogenic or mixed origin (p<0.00001) more efficiently compared to no treatment. Contrary to current belief, occlusal adjustment could result in a more effective pain reduction compared to different control groups (p=0.01). The long-term effectiveness of the interventions could not be sufficiently investigated due to the limited data available. Registration number of the review at PROSPERO: CRD42019123169. KW - Gesichtsschmerz KW - Aufbissschiene KW - Metaanalyse KW - Chronischer Schmerz KW - Systematische Übersichtsarbeit KW - Craniomandibuläre Dysfunktion KW - Okklusale Adjustierung KW - Okklusionsschiene KW - Schmerzchronifizierung KW - systematic review KW - meta-analysis KW - temporomandibular disorders KW - occlusal splint KW - occlusal adjustment Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-256755 ER - TY - THES A1 - Schnabel, Eva T1 - Alcohol and driving-related performance - A comprehensive meta-analysis focusing the significance of the non-significant T1 - Alkohol und fahrrelevante Leistungen - Eine umfassende Metaanalyse N2 - The present work reviews the experimental literature on the acute effects of alcohol on human behaviour related to driving performance. A meta-analysis was conducted which includes studies published between 1954 and 2007 in order to provide a comprehensive knowledge of the substance alcohol. 450 studies reporting 5,300 findings were selected from over 12,000 references after applying certain in- and exclusion criteria. Thus, the present meta-analysis comprises far more studies than reviews on alcohol up to now. In the selected studies, different performance tests were conducted which were relevant for driving. The classification system used in this work assigns these tests to eight categories. The main categories consist of several sub categories classifying the tasks more precisely. The main categories were: (1) visual functions, (2) attention (including vigilance), (3) divided attention, (4) en-/decoding (including information processing and memory), (5) reaction time (including simple reaction time and choice reaction time), (6) psychomotor skills, (7) tracking and (8) driving. In addition to the performance aspect, the classification system takes into account mood and social behaviour variables related to driving safety like tiredness or aggression. Following the evaluation method of vote-counting, the number of significant findings and the number of non-significant findings were summarised per blood alcohol concentration (BAC) group. Thereby, a quantitative estimation of the effects of alcohol depending on the BAC was established, the so-called impairment function, which shows the percentage of significantly impaired findings. In order to provide a general overview of alcohol effects on driving-related performance, a global impairment function was established by aggregating all performance findings. The function is nearly linear with about 30% significant findings at a BAC of 0.05% and 50% significant findings at a BAC of 0.08%. In addition, more specific impairment functions considering only the findings of the single behavioural categories were calculated. The results revealed that impairment depends not only on the BAC, but also clearly differs between most of the performance categories. Tracking and driving performance were most affected by alcohol with impairment beginning at very low BACs of 0.02%. Also psychomotor skills were considerably affected by rather low BACs. Impairment of visual functions and information processing occurred at BACs of 0.04% and increased substantially with higher BACs. Impairment in memory tests could be found with very low BACs of 0.02%, but varied depending on the kind of memory. Performance decrements in divided attention tests could also be found with very low BACs in some studies. Attention started to be impaired at 0.04% BAC, but – as in vigilance tasks – considerable impairment only occurred at higher BACs. Choice reaction time was affected at lower BACs than simple reaction time, which was – together with the critical flicker fusion frequency – the least sensitive parameter to the effects of alcohol. To conclude, most skills which are relevant for the safe operation of a vehicle are clearly impaired by BACs of 0.05%, with motor functions being more affected than cognitive functions and complex tasks more than simple tasks. Generally, the results provided no evidence of a threshold effect for alcohol. There was no driving-related performance category for which a sudden transition from unimpaired to impaired occurred at a particular BAC level. In addition, a comparison was made between the present meta-analysis and two reviews of Moskowitz (Moskowitz & Fiorentino, 2000; Moskowitz & Robinson, 1988). Moskowitz reported much lower BACs at which performance was impaired. The reasons for this discrepancy lies in a different way to review scientific findings. On the one hand, Moskowitz focused on significant findings when selecting studies and findings for his reviews. On the other hand, the evaluation method used by Moskowitz ignored non-significant findings and counted each study once at the lowest BAC for which impairment was found. Those non-significant findings are as important as the significant ones in order to determine thresholds of impairment. Therefore, in contrast to Moskowitz, the present work describes the effects of alcohol with functions considering also the non-significant findings. The significance of the non-significant is emphasized with respect to the selection procedure as well as to the evaluation method. N2 - Die vorliegende Arbeit gibt einen umfassenden Überblick experimenteller Studien, die die akute Wirkung von Alkohol auf fahrrelevante Leistungen untersuchen. Hierzu wurde eine Metaanalyse durchgeführt, in der Studien von 1954 bis 2007 berücksichtigt wurden. Aus über 12.000 Referenzen wurden 450 Studien mit insgesamt 5.300 Befunden nach vorher festgelegten Ein- und Ausschlusskriterien ausgewählt. So umfasst die vorliegende Metaanalyse weit mehr Studien als die bisherigen veröffentlichten Literaturüberlicke. In den ausgewählten Studien kamen verschiedene Leistungstests zur Anwendung, um die Effekte von Alkohol auf fahrrelevante Leistungen zu überprüfen. Diese Tests wurden in acht Kategorien klassifiziert: (1) visuelle Funktionen, (2) Aufmerksamkeit (einschließlich Vigilanz), (3) geteilte Aufmerksamkeit, (4) En-/ Dekodierung (einschließlich Informationsverarbeitung und Gedächtnis), (5) Reaktionszeit (einschließlich Einfachreaktionszeit und Wahlreaktionszeit), (6) psychomotorische Fähigkeiten, (7) Tracking und (8) Fahren. Neben den Leistungsaspekten berücksichtigt das in der vorliegenden Arbeit verwendete Klassifikationssystem auch andere für die Fahrleistung relevante Aspekte der beiden Bereiche subjektives Befinden und soziales Verhalten, wie beispielsweise Müdigkeit oder Aggressivität. Gemäß der Vote-counting-Methode wurde die Anzahl der signifikanten und nicht-signifikanten Befunde für verschiedene Blutalkoholkonzentrationsgruppen zusammengezählt. Daraus ergab sich eine quantitative Schätzung der Effekte von Alkohol in Abhängigkeit der Blutalkoholkonzentration (BAK), die sogenannte Beeinträchtigungsfunktion. Diese stellt den Prozentsatz an signifikanten Befunden, die eine Beeinträchtigung berichteten, dar. Um einen allgemeinen Überblick über Alkohol und die Effekte auf die Fahrleistung zu geben, wurde eine globale Beeinträchtigungsfunktion aufgestellt, in die alle Leistungsbefunde eingegangen sind. Diese Funktion ist nahezu linear mit etwa 30% signifikanten Befunden bei einer BAK von 0,05% und 50% signifikanten Befunde bei einer BAK von 0,08%. Darüber hinaus wurden spezifische Beeinträchtigungsfunktionen berechnet, in denen die jeweiligen Befunde der einzelnen Kategorien berücksichtigt wurden. Die Ergebnisse zeigten, dass die Beeinträchtigung nicht nur von der BAK abhängt, sondern auch von der geforderten Leistung. Tracking- und Fahrleistung waren dabei am stärksten betroffen. Hier zeigten sich bereits bei sehr geringen BAK von 0,02% Beeinträchtigungen. Auch psychomotorische Fähigkeiten wurden beträchtlich durch geringe BAK beeinträchtigt. Eine Beeinträchtigung der visuellen Funktionen und Informationsverarbeitung trat bei einer BAK von 0,04% auf und verstärkte sich deutlich mit höheren BAK. Eine Beeinträchtigung in Gedächtnistests konnte bei sehr geringen BAK von 0,02% gefunden werden, wobei diese in Abhängigkeit von der Art der Gedächtnistests variierte. Eine Abnahme der Leistung in Tests zu geteilter Aufmerksamkeit konnte in einigen Studien ebenfalls bei sehr geringen BAK gefunden werden. Eine Beeinträchtigung der Aufmerksamkeit trat bei einer BAK von 0,04% auf, aber erst bei höheren BAK kam es – wie bei Vigilanzaufgaben – zu erheblichen Beeinträchtigungen. Die Einfachreaktionszeit war zusammen mit der Flicker-Verschmelzungsfrequenz der am wenigsten sensitive Parameter für Alkoholeffekte. Zusammenfassend lässt sich sagen, dass die meisten Fertigkeiten, die für das sichere Führen eines Fahrzeugs relevant sind, ab einer BAK von 0,05% deutlich beeinträchtigt sind. Die motorischen Fertigkeiten sind dabei stärker betroffen als die kognitiven Funktionen, und komplexe Aufgaben stärker als einfache Aufgaben. Generell lieferten die Ergebnisse keinen Hinweis für einen Schwelleneffekt von Alkohol. Das heißt es gab keine fahrrelevante Leistungskategorie, bei der bei einer bestimmten BAK-Stufe ein plötzlicher Übergang von unbeeinträchtigt zu beeinträchtigt auftrat. Um Schwellen für ein Auftreten der Beeinträchtigung zu bestimmen, sind nicht-signifikante Befunde genauso wichtig wie signifikante. Die vorliegende Arbeit hebt die Bedeutung der Nichtsignifikanz sowohl für das Auswahlverfahren der Studien als auch für die Auswertungsmethode explizit hervor und beschreibt die Effekte von Alkohol durch Funktionen, die auch nicht-signifikante Befunde berücksichtigen. KW - Trunkenheit im Verkehr KW - Alkohol KW - Fahrerverhalten KW - Fahren KW - Leistung KW - Review KW - experimentelle Studien KW - Leistungstests KW - Metaanalyse KW - Alcohol KW - performance KW - driving KW - meta-analysis KW - review Y1 - 2011 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-69959 ER -