Assessment Of Multiple Systematic Reviews Score Research Articles

Static vs Dynamic Fixation of Distal Tibiofibular Syndesmosis: A Review of Overlapping Meta-Analyses

Category:Ankle; SportsIntroduction/Purpose:Multiple Level I meta-analyses have been led comparing traditional static vs. more recently-introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence.Methods:In this systematic review, conducted in accordance with the PRISMA guidelines, we identified meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury. Robustness of studies was evaluated using the Fragility Index (FI) for meta-analysis and the Fragility Quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews(AMSTAR) instrument. Finally, the Jadad Decision Algorithm was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions.Results:Out of 1302 records, 4 Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9) while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had a FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far.Conclusion:We selected the meta-analysis by Grassi et al. as the highest quality provided so far, which found that dynamic fixation reduced complication rates and improved clinical outcomes compared to static methods of fixation. We demonstrated that meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than 4 patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant. Based on these findings, we recommend caution when interpreting the results of these studies.

Static versus dynamic fixation of distal tibiofibular syndesmosis: a systematic review of overlapping meta-analyses.

Multiple Level I meta-analyses were conducted comparing traditional static vs. more recently introduced dynamic strategies of fixation for injuries of the distal tibiofibular syndesmosis (TFS). The aim of this review was to assess their robustness and methodological quality, providing support in the choice of a treatment strategy in case of TFS injury using the highest level of evidence. In this systematic review, conducted in accordance with the PRISMA guidelines, meta-analyses/systematic reviews comparing static and dynamic fixation methods after acute TFS injury were identified. The robustness of studies was evaluated using the fragility index (FI) for meta-analysis and the fragility quotient (FQ). The risk of bias was evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Finally, the Jadad was applied to select the study which provided the highest quality of evidence to develop recommendations for the fixation strategy of these lesions. Out of 1.302 records, four Level I meta-analyses were included in this study. Analyzing the statistically significant dichotomous outcomes, the median FI was 3.5 (IQR, 2 to 5.5; range, 1 to 9), while the median FQ was 1.9% (IQR, 1 to 3.5; range 0.35 to 4.4). In total, 37% had an FI of 2 or less and 75% of outcomes had a FI of 4 or less. According to the AMSTAR score and Jadad algorithm, the largest meta-analysis was selected as the highest evidence provided so far. The meta-analyses with statistically significant dichotomous outcomes comparing dynamic and static fixation for treating injuries of the distal tibiofibular syndesmosis are fragile, with a change in less than four patients or less than 2% of the study population sufficient to reverse a significant outcome to nonsignificant. Level I.

Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments.

While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient-reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8±1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy-related pain and improve self-reported function.

Effect of medication reconciliation interventions on outcomes: A systematic overview of systematic reviews.

To evaluate and summarize published evidence from systematic reviews examining medication reconciliation. MEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for English-language systematic reviews published from January 2004 to March 2019. Reviewers independently extracted information and scored review quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. For reviews with AMSTAR scores above 7, Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality, with evidence summarized and conclusions compared across reviews. Eleven reviews met the inclusion criteria, 5 of which used meta-analytic pooling. Most systematic reviews included primary studies of comprehensive bundled interventions that featured medication reconciliation as a central component. Reviews largely focused on transitions into and out of hospital settings. Five reviews focused exclusively on pharmacist-led interventions. Of the 5 reviews that considered all types of medication discrepancies, 3 reviews found very low-quality evidence that interventions reduced medication discrepancies. Neither of the 2 reviews that examined clinically significant medication discrepancies found any intervention effect. Of the 5 reviews that examined healthcare utilization outcomes, only 1 found any intervention effect, and that finding was based on low- to very low-quality evidence. Four reviews considered clinical outcomes, but none found any intervention effect. An overview of systematic reviews of medication reconciliation interventions found 9 high-quality systematic reviews. A minority of those reviews' conclusions were consistent with medication reconciliation alone having a measurable impact, and such conclusions were almost all based on very low-quality evidence.

Potential risks of rare serious adverse effects related to long-term use of bisphosphonates: An overview of systematic reviews.

There have been concerns about a potential link between long-term use of bisphosphonates (BPs) for the treatment of osteoporosis and rare serious adverse effects, such as atypical femoral fractures. However, many reviews exist with conflicting conclusions about this issue. The aim of this overview of reviews was to systematically evaluate the risk of rare serious adverse effects of long-term use of BPs for the treatment of osteoporosis. We identified systematic reviews with meta-analyses of randomized controlled trials (RCTs) and (or) observational studies published in English or Chinese that evaluated the safety of BPs through to December 2018. The Cochrane library, PubMed, Web of Science and hand-searching of reference lists and clinical practice guidelines were electronically searched for data sources. Carcinogenicity, atypical fracture, osteonecrosis of jaw (ONJ) and fracture union time were specified as the primary outcomes. The methodological quality of each systematic review was assessed by two reviewers using the Assessment of Multiple Systematic Reviews (AMSTAR) tool, and the quality of evidence for key outcomes was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. In total, 1376 potentially relevant citations were identified, of which only 8 systematic reviews with meta-analyses met the eligibility criteria. All the included reviews were published between 2012 and 2015 and documented the pooled estimates of effect size (relative risk [RR], odds ratio [OR] or hazard ratio [HR] and their 95% confidence intervals [95% CI]) for the incidence of adverse events. All included systematic reviews were of moderate or high quality. The median AMSTAR score was 7.5 (interquartile range, 5-10). However, evidence of the key outcomes was mainly of very low or moderate quality. BP treatment only increased the risk of atypical fracture and ONJ, and prolonged union time compared with placebo or other anti-osteoporosis drugs (P＜.05). This study indicated that long-term use of BPs could increase the risk of rare serious adverse effects, but the relationship between long-term use of BPs and carcinogenicity was often uncertain. Therefore, high-quality research and more complete inclusion criteria are needed.

Hypothyroidism and related diseases: a methodological quality assessment of meta-analysis

ObjectivesThere is an increasing prevalence of hypothyroidism and there is a growing body of meta-analyses (MAs) on the association between hypothyroidism and other diseases. However, the methodological quality of the...

Reporting and Methodological Quality of Systematic Reviews and Meta-Analyses of Nursing Interventions in Patients With Alzheimer's Disease: General Implications of the Findings.

The aim of this study was to evaluate the reporting characteristics as well as the methodological quality of systematic reviews (SRs) and meta-analyses (MAs) of nursing interventions in patients with Alzheimer's disease and determine potential factors for high quality. Following the inclusion and exclusion criteria, we searched the databases PubMed, EMBASE, and The Cochrane Library from inception through October 1, 2017. Two reviewers independently selected articles and extracted data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and Assessment of Multiple Systematic Reviews (AMSTAR) checklist were adopted to evaluate reporting and methodological quality, respectively. A total of 64 eligible articles, published from 2001 to 2017, were included. The mean PRISMA and AMSTAR scores were 19.310 ± 4.167 and 6.390 ± 2.208, respectively. For the PRISMA checklist, the following characteristics had less than 50% compliance: protocol or registration, full electronic search strategy, summary measures, risk for bias across studies, and synthesis of results. For the AMSTAR checklist, the following characteristics had less than 50% compliance: a priori study design, comprehensive literature search, status of publication used as inclusion criteria, scientific quality, publication bias, and conflicts of interest stated. Logistic regression analyses indicated that systematic reviews including meta-analyses that followed PRISMA guidelines, had a protocol or registration, and had funding support were related to higher reporting quality; systematic reviews including meta-analyses that had a protocol or registration were related to higher methodological quality. The reporting and methodological quality of systematic reviews and meta-analyses of nursing interventions in patients with Alzheimer's disease were suboptimal, with some areas needing further improvement. More endorsement by journals of the reporting guidelines for SRs and MAs may improve article quality and the dissemination of reliable evidence to nurses. We recommend that authors, readers, reviewers, and editors become better acquainted with and adhere more strictly to the PRISMA and AMSTAR checklists.

Is Unilateral Percutaneous Kyphoplasty Superior to Bilateral Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures? Evidence from a Systematic Review of Discordant Meta-Analyses

Several meta-analyses have been performed to compare unilateral percutaneous kyphoplasty (PKP) and bilateral PKP in the treatment of osteoporotic vertebral compression fractures (OVCFs), but inconsistencies in the results have led to questions as to which technique is preferable. This study was designed to clarify the benefits and disadvantages of unilateral PKP versus bilateral PKP as found in numerous discordant meta-analyses and thereby present surgical treatment recommendations for OVCFs considering the current best evidence. Systematic review/Meta-analysis. Meta-analyses on unilateral and bilateral PKP for OVCFs were included by searching Pubmed, Embase, and Cochrane library. Meta-analysis quality was assessed using Oxford Levels of Evidence and Assessment of Multiple Systematic Reviews (AMSTAR). The Jadad decision algorithm was used to identify the best evidence. Eight eligible meta-analyses were included, 7 of which were Level-II evidence and one was Level-III evidence. The AMSTAR scores varied from 7 to 8. The Jadad decision algorithm suggested that the best meta-analysis should be selected depending upon publication characteristics and methodology of primary studies, language restrictions, and whether data analysis was performed on individual patients. The best available evidence indicated that both unilateral and bilateral PKP could receive similar good clinical and radiological outcomes. However, without increasing the risk of complications, unilateral PKP required shorter surgical time and less cement volume, offering better pain relief and quality of life at post-operative short term follow-ups. Primary studies had defects in their methodologies. Unilateral PKP appears to be superior to bilateral PKP in the treatment of OVCFs. Osteoporotic vertebral compression fractures, percutaneous kyphoplasty, meta-analysis.

How is AMSTAR applied by authors \u2013 a call for better reporting

BackgroundThe assessment of multiple systematic reviews (AMSTAR) tool is widely used for investigating the methodological quality of systematic reviews (SR). Originally, AMSTAR was developed for SRs of randomized controlled trials (RCTs). Its applicability to SRs of other study designs remains unclear. Our objectives were to: 1) analyze how AMSTAR is applied by authors and (2) analyze whether the authors pay attention to the original purpose of AMSTAR and for what it has been validated.MethodsWe searched MEDLINE (via PubMed) from inception through October 2016 to identify studies that applied AMSTAR. Full-text studies were sought for all retrieved hits and screened by one reviewer. A second reviewer verified the excluded studies (liberal acceleration). Data were extracted into structured tables by one reviewer and were checked by a second reviewer. Discrepancies at any stage were resolved by consensus or by consulting a third person. We analyzed the data descriptively as frequencies or medians and interquartile ranges (IQRs). Associations were quantified using the risk ratio (RR), with 95% confidence intervals.ResultsWe identified 247 studies. They included a median of 17 reviews (interquartile range (IQR): 8 to 47) per study. AMSTAR was modified in 23% (57/247) of studies. In most studies, an AMSTAR score was calculated (200/247; 81%). Methods for calculating an AMSTAR score varied, with summing up all yes answers (yes = 1) being the most frequent option (102/200; 51%). More than one third of the authors failed to report how the AMSTAR score was obtained (71/200; 36%). In a subgroup analysis, we compared overviews of reviews (n = 154) with the methodological publications (n = 93). The overviews of reviews were much less likely to mention both limitations with respect to study designs (if other studies other than RCTs were included in the reviews) (RR 0.27, 95% CI 0.09 to 0.75) and overall score (RR 0.08, 95% CI 0.02 to 0.35).ConclusionsAuthors, peer reviewers, and editors should pay more attention to the correct use and reporting of assessment tools in evidence synthesis. Authors of overviews of reviews should ensure to have a methodological expert in their review team.

Comparison of methodological quality rating of systematic reviews on neuropathic pain using AMSTAR and R-AMSTAR

BackgroundSystematic reviews (SRs) in the field of neuropathic pain (NeuP) are increasingly important for decision-making. However, methodological flaws in SRs can reduce the validity of conclusions. Hence, it is important to assess the methodological quality of NeuP SRs critically. Additionally, it remains unclear which assessment tool should be used. We studied the methodological quality of SRs published in the field of NeuP and compared two assessment tools.MethodsWe systematically searched 5 electronic databases to identify SRs of randomized controlled trials of interventions for NeuP available up to March 2015. Two independent reviewers assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) and the revised AMSTAR (R-AMSTAR) tools. The scores were converted to percentiles and ranked into 4 grades to allow comparison between the two checklists. Gwet’s AC1 coefficient was used for interrater reliability assessment.ResultsThe 97 included SRs had a wide range of methodological quality scores (AMSTAR median (IQR): 6 (5–8) vs. R-AMSTAR median (IQR): 30 (26–35)). The overall agreement score between the 2 raters was 0.62 (95% CI 0.39–0.86) for AMSTAR and 0.62 (95% CI 0.53–0.70) for R-AMSTAR. The 31 Cochrane systematic reviews (CSRs) were consistently ranked higher than the 66 non-Cochrane systematic reviews (NCSRs). The analysis of individual domains showed the best compliance in a comprehensive literature search (item 3) on both checklists. The results for the domain that was the least compliant differed: conflict of interest (item 11) was the item most poorly reported on AMSTAR vs. publication bias assessment (item 10) on R-AMSTAR. A high positive correlation between the total AMSTAR and R-AMSTAR scores for all SRs, as well as for CSRs and NCSRs, was observed.ConclusionsThe methodological quality of analyzed SRs in the field of NeuP was not optimal, and CSRs had a higher quality than NCSRs. Both AMSTAR and R-AMSTAR tools produced comparable quality ratings. Our results point out to weaknesses in the methodology of existing SRs on interventions for the management NeuP and call for future improvement by better adherence to analyzed quality checklists, either AMSTAR or R-AMSTAR.

The Quality of Systematic Reviews in Head and Neck Microsurgery: A Perspective from Plastic Surgery and Otolaryngology.

In recent years, there has been a push to publish higher level of evidence studies in medicine, particularly in plastic surgery. Well-conducted systematic reviews are considered the strongest level of evidence in medicine, recently becoming the key process indicators for quality delivery. A varying quality of systematic reviews, however, has led to concerns of their validity in clinical decision-making. We perform a quality analysis of systematic reviews published in head and neck microsurgery by the surgical specialties of plastic surgery and otolaryngology. An evaluation of systematic reviews published on microsurgery in 13 high-impact surgical journals was conducted by searching PubMed and Scopus. Two authors independently performed searches, screened for eligibility, and extracted data from included articles. Discrepancies were resolved by discussion and consensus. Assessment of Multiple Systematic Reviews (AMSTAR) criteria were used to assess methodological quality. The initial database search retrieved 166 articles. After removing duplicates, screening titles and abstracts, 26 articles remained for full text review. Seven did not focus on head and neck microsurgery and were further excluded, leaving 19 systematic reviews for final analysis. Of those, 10 systematic reviews were published by otolaryngology, and 9 were published by plastic surgery. Median AMSTAR score was 8 for otolaryngology, 7 for plastic surgery, and 8 overall, reflecting "fair to good" quality. The number of systematic reviews on head and neck microsurgery markedly increased over time. Of note, both the AMSTAR score and the number of systematic reviews published by plastic surgery have steadily increased from 2014 to 2016, whereas those published by otolaryngology have remained relatively stable since 2010. Our review shows a trend toward publishing more systematic reviews. The increasing quantity and quality of systematic reviews published by plastic surgeons indicates recognition in the need for higher levels of evidence in plastic surgery, as well as growing interest and advances in microsurgery. Given these trends, familiarity with quality assessment guidelines, such as AMSTAR, will remain important in providing a basis for building relevant value-based quality measures.

Elements of integrated care approaches for older people: a review of reviews

ObjectiveThe World Health Organization (WHO) recently proposed an Integrated Care for Older People approach to guide health systems and services in better supporting functional ability of older people. A knowledge...

Intramedullary fixation versus plate fixation for displaced mid-shaft clavicle fractures: A systematic review of overlapping meta-analyses.

Background:Displaced mid-shaft clavicle fractures (DMCFs) are common injuries. Both intramedullary fixation (IMF) and plate fixation (PF) have been described and routinely used. Multiple trials have been conducted to compare these treatments. Multiple meta-analyses have been published to compare IMF and PF treatment for DMCFs; however, the results remain controversial. The purposes of this study were to perform a systematic review of overlapping meta-analyses comparing IMF and PF treatment for DMCFs, to help decision makers critically evaluate the current meta-analyses, and to propose a guide through the best available evidence.Method:We searched the Cochrane library, PubMed, and EMBASE data bases. Two authors independently scanned titles and abstracts to exclude irrelevant articles and identify meta-analyses that met the eligibility criteria. The methodological quality of the meta-analysis was independently assessed by the 2 authors using the Oxford Centre for Evidence-based Medicine Levels of Evidence and the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Heterogeneity information of each variable was extracted from the included studies. An I2 of <60% is accepted in this systematic review. The Jadad algorithm was then applied to determine which of the meta-analyses provided the best evidence.Results:Eight meta-analysis met the inclusion criteria in this study. AMSTAR scores varied from 7 to 9. Heterogeneity of each outcome was acceptable. Four authors independently selected the same meta-analysis as providing the highest quality of evidence using the Jadad decision algorithm.Conclusion:This systematic review of overlapping meta-analyses suggests that compared with PF, major reintervention and refracture after implant removal occurred more frequently after PF of DMCFs. No differences in terms of function and non-union between PF and IMF were observed. Future research should focus on fracture selection for IMF and further improvement of plates and IM devices.

Exercise and cancer-related fatigue in adults: a systematic review of previous systematic reviews with meta-analyses

BackgroundConduct a systematic review of previous systematic reviews with meta-analysis to determine the effects of exercise (aerobic, strength or both) on cancer-related-fatigue (CRF) in adults with any type of cancer.MethodsSystematic reviews with meta-analyses of previous randomized controlled trials published through July of 2016 were included by searching six electronic databases and cross-referencing. Dual-selection and data abstraction were conducted. Methodological quality was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) instrument. Standardized mean differences (SMD) that were pooled using random-effects models were included as the effect size. In addition, 95% prediction intervals (PI), number needed-to-treat (NNT) and percentile improvements were calculated.ResultsSixteen studies representing 2 to 48 SMD effect sizes per analysis (mean ± SD, 7 ± 8, median = 5) and 37 to 3254 participants (mean ± SD, 633 ± 690, median = 400) were included. Length of training lasted from 3 to 52 weeks (mean ± SD, 14.6 ± 3.1, median = 14), frequency from 1 to 10 times per week (mean ± SD, 3.4 ± 0.8, median = 3), and duration from 10 to 120 min per session (mean ± SD, 44.3 ± 5.5, median = 45). Adjusted AMSTAR scores ranged from 44.4% to 80.0% (mean ± SD, 68.8% ± 12.0%, median = 72.5%). Overall, mean SMD improvements in CRF ranged from −1.05 to −0.01, with 22 of 55 meta-analytic results (52.7%) statistically significant (non-overlapping 95% CI). When PI were calculated for results with non-overlapping 95% CI, only 3 of 25 (12%) yielded non-overlapping 95% PI favoring reductions in CRF. Number needed-to-treat and percentile improvements ranged from 3 to 16 and 4.4 to 26.4, respectively.ConclusionsA lack of certainty exists regarding the benefits of exercise on CRF in adults. However, exercise does not appear to increase CRF in adults.Trial registrationPROSPERO Registration # CRD42016045405.

Intratympanic steroid intervention as initial therapy for sudden sensorineural hearing loss: a systematic review of reviews

Objective:The aim of this overview is to evaluate the relevant systematic reviews and Meta-analysis that focus on intratympanic steroid intervention as initial therapy for sudden sensorineural hearing loss.Method:The literature search was based on the published systematic reviews and Meta analysis. According to the include and exclude critera, the important data was extracted. Quality assessment was rigorously performed using the 11-item Assessment of Multiple Systematic Reviews (AMSTAR) and main outcome indicators of literature evidence quality were evaluated by Grading of Recommendations, Assessment, Development and Evaluation (GRADE).Result:Sixteen related systemic reviews and Meta-analysis (6 Chinese literatures and 10 English literatures) published during 2009-2016 were included; AMSTAR score was 4 to 9 points,14 studies was medium quality and 2 was high quality. However, the clinical evidence was controversial and there is no consensus regarding the efficacy of intratympanic steroid therapy for sudden sensorineural hearing loss.Conclusion:As an initial treatment, there is no sufficient high quality evidence to recommend the ITS therapy. There is a need for further systematic reviews that adhere to strict scientific methods.

Methodological quality and reporting of systematic reviews in hand and wrist pathology.

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Chewing gum for postoperative ileus after colorectal surgery: A systematic review of overlapping meta-analyses

Abstract Background Many meta-analyses investigating gum chewing for postoperative recovery after colorectal surgery have been published with inconsistent findings. Therefore, we performed this study to systematically review these overlapping meta-analyses and offer clinical recommendations based on the current best evidence for decision makers. Methods Multiple databases, including PubMed, EMBASE, Cochrane Library, Chinese BioMedical Literature on disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Chinese Wanfang and Chinese VIP, were searched through October 2016. We included meta-analyses investigating the effectiveness of chewing gum for postoperative ileus after colorectal resection. Two investigators independently scanned and evaluated eligible meta-analyses, extracted essential information, assessed the methodological quality with the Assessment of Multiple Systematic Reviews (AMSTAR) tool and Oxford Levels of Evidence, and used the Jadad decision algorithm at each step for all procedures. Heterogeneity ≤50% was accepted. Results Ten meta-analyses were included in our study. The AMSTAR scores varied from 5 to 9, with a median of 7.7. Most heterogeneity fell into the acceptable range. After implementing the Jadad decision algorithm, two meta-analyses of RCTs were selected based on search strategies and the implications of selection. The available best evidence indicated that gum chewing significantly reduced time to first flatus, time to first bowel movement, time to first bowel sounds and length of hospital stay. However, these two meta-analyses reached inconsistent conclusions as to the complications and economic benefits. Conclusions With the current best available evidence, we suggest gum chewing is beneficial for gastrointestinal function and reducing postoperative ileus.

Impact of ambient temperature on morbidity and mortality: An overview of reviews.

The objectives were (i) to conduct an overview of systematic reviews to summarize evidence from and evaluate the methodological quality of systematic reviews assessing the impact of ambient temperature on morbidity and mortality; and (ii) to reanalyse meta-analyses of cold-induced cardiovascular morbidity in different age groups. The registration number is PROSPERO-CRD42016047179. PubMed, Embase, the Cochrane Library, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Global Health were systematically searched to identify systematic reviews. Two reviewers independently selected studies for inclusion, extracted data, and assessed quality. The Assessment of Multiple Systematic Reviews (AMSTAR) checklist was used to assess the methodological quality of included systematic reviews. Estimates of morbidity and mortality risk in association with heat exposure, cold exposure, heatwaves, cold spells and diurnal temperature ranges (DTRs) were the primary outcomes. Twenty-eight systematic reviews were included in the overview of systematic reviews. (i) The median (interquartile range) AMSTAR scores were 7 (1.75) for quantitative reviews and 3.5 (1.75) for qualitative reviews. (ii) Heat exposure was identified to be associated with increased risk of cardiovascular, cerebrovascular and respiratory mortality, but was not found to have an impact on cardiovascular or cerebrovascular morbidity. (iii) Reanalysis of the meta-analyses indicated that cold-induced cardiovascular morbidity increased in youth and middle-age (RR=1.009, 95% CI: 1.004-1.015) as well as the elderly (RR=1.013, 95% CI: 1.007-1.018). (iv) The definitions of temperature exposure adopted by different studies included various temperature indicators and thresholds. In conclusion, heat exposure seemed to have an adverse effect on mortality and cold-induced cardiovascular morbidity increased in the elderly. Developing definitions of temperature exposure at the regional level may contribute to more accurate evaluations of the health effects of temperature.

157: ASSESSING THE METHODOLOGICAL QUALITY OF DECISION SUPPORT SYSTEM (DSS) SYSTEMATIC REVIEWS BY AMSTAR CHECKLIST

Background and aims:It is all accepted that high-quality evidence is essential for clinical decision making. As Haynes “6S pyramid”, systems including decision support systems are at the top of this...

Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: a systematic review of overlapping meta-analyses

Several meta-analyses comparing early functional rehabilitation and traditional immobilization following surgical Achilles tendon repair after acute rupture have been published. However, they have led to conflicting conclusions. The aims of this systematic review were to select high-quality meta-analyses from multiple discordant meta-analyses and to provide a postoperative rehabilitation strategy following surgical repair using currently available evidence. We performed a comprehensive search using the PubMed and Embase databases and the Cochrane Library. Assessment of Multiple Systematic Reviews (AMSTAR) instrument was used to assess the methodological quality. Three investigators independently applied the Jadad decision algorithm. Their results were then compared to ensure selection of a meta-analysis that provided the highest quality of evidence. Six meta-analyses met the eligibility criteria. AMSTAR scores ranged from 6 to 10. According to the Jadad decision algorithm, a high-quality meta-analysis with a greater number of RCTs was selected. This meta-analysis showed that early functional rehabilitation was superior to cast immobilization in terms of patient satisfaction and the time to return to pre-morbid sporting levels. There were no differences regarding major complications or the time before return to prior employment and sporting activity. Thus, we recommend early functional rehabilitation as the postoperative strategy for acute Achilles tendon ruptures.