Bias In Systematic Reviews Research Articles

Stigma, Secrecy and Masculine Norms: A Systematic Review of How Perinatal Mental Illness in Men and Their Partners Is Experienced by Males

AimsBackground: In recent years, fathers have become increasingly involved in pregnancy and childcare and the concept of paternal perinatal mental illness (PMI) has gained research interest. There has been increased recognition of the impact of parenthood on the mental health of males, particularly in first time fathers where feelings of helplessness and marginalisation are common. Prevalence of paternal PMI is thought to be 10–16%, with higher risk demonstrated when their partner too experiences PMI. The importance of this topic was highlighted in the NHS long term plan, which recognised the disparity in service provision between males and females and the need to address this. Aim: To conduct a systematic review to establish the knowledge, beliefs, and experiences of males with PMI and whose partners had PMI, and to understand the barriers associated with help-seeking for paternal PMI.MethodsFive databases including EMBASE, Web of Science, Ovid MEDLINE, Scopus and PsycINFO were searched for qualitative studies investigating the experiences of males affected by PMI personally or through their partner's illness. The research question and inclusion criteria were determined using the PICOSS (population, intervention, comparison, outcome, setting, study design) method. 11 studies met criteria for inclusion and were appraised for quality using the Critical Appraisal Skills Programme and Joanna Briggs Institute Qualitative checklists. Evidence was synthesised using thematic analysis and study quality and risk of bias were assessed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) checklist and Risk of Bias in Systematic Reviews (ROBIS) too.Results5 main themes and 17 sub-themes were identified, and demonstrated lack of knowledge and preparation for fatherhood, and distress and isolation experienced by males with PMI. Males were reluctant to seek help, and factors including stigma and lack of awareness regarding PMI and available support services were identified as barriers. The option to remain anonymous, flexibility of appointments and an emphasis on peer support were considered facilitators to engagement.ConclusionUnhelpful and potentially damaging stereotypes regarding masculinity and PMI still exist, prohibit help-seeking for PMI and promote the marginalisation of males in perinatal settings. Support for males with PMI is warranted but lacking, and effective communication and education regarding paternal PMI for both professionals and the public is needed to allow successful expansion of services to include males.

Prenatal exposure to ambient air pollutants and congenital heart defects: An umbrella review

BackgroundPrenatal exposure to ambient air pollutants has been linked to congenital heart defects (CHD), but findings of existing systematic reviews have been mixed. ObjectiveTo assess the epidemiological evidence on associations between prenatal exposure to ambient air pollutants and CHD subtypes, based on a systematic overview of reviews (“umbrella review”). MethodsWe conducted a systematic search for reviews assessing associations between prenatal exposure to criteria air pollutants and CHD. The risk of bias was evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool. The certainty of the systematic review findings was graded using the Navigation Guide methodology. ResultsWe identified eleven systematic reviews, including eight with meta-analyses, assessing in total 35 primary studies of prenatal exposure to criteria air pollutants and various CHD subtypes. The certainty of the findings of four meta-analyses indicating an increased risk for coarctation of the aorta associated with nitrogen dioxide exposure was rated as moderate. The certainty of findings indicating positive, inverse, or null associations for other pollutant-subtype combinations was rated as very low to low, based on low precision and high statistical heterogeneity of summary odds ratios (SOR), substantial inconsistencies between review findings, and methodological limitations of the systematic reviews. DiscussionThe inconsistent findings and high statistical heterogeneity of many SOR of the included systematic reviews may partly be traced to differences in methodological approaches, and the risk of bias across included reviews (e.g., inclusion criteria, systematic search strategies, synthesis methods) and primary studies (e.g., exposure assessment, diagnostic criteria). Adherence to appropriate systematic review guidelines for environmental health research, as well as rigorous evaluation of risk of bias in primary studies, are essential for future risk assessments and policy-making. Still, our findings suggest that prenatal exposure to ambient air pollutants may increase risks for at least some CHD subtypes.

An overview of meta-analyses on radiomics: more evidence is needed to support clinical translation

ObjectiveTo conduct an overview of meta-analyses of radiomics studies assessing their study quality and evidence level.MethodsA systematical search was updated via peer-reviewed electronic databases, preprint servers, and systematic review protocol registers until 15 November 2022. Systematic reviews with meta-analysis of primary radiomics studies were included. Their reporting transparency, methodological quality, and risk of bias were assessed by PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 checklist, AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews, version 2) tool, and ROBIS (Risk Of Bias In Systematic reviews) tool, respectively. The evidence level supporting the radiomics for clinical use was rated.ResultsWe identified 44 systematic reviews with meta-analyses on radiomics research. The mean ± standard deviation of PRISMA adherence rate was 65 ± 9%. The AMSTAR-2 tool rated 5 and 39 systematic reviews as low and critically low confidence, respectively. The ROBIS assessment resulted low, unclear and high risk in 5, 11, and 28 systematic reviews, respectively. We reperformed 53 meta-analyses in 38 included systematic reviews. There were 3, 7, and 43 meta-analyses rated as convincing, highly suggestive, and weak levels of evidence, respectively. The convincing level of evidence was rated in (1) T2-FLAIR radiomics for IDH-mutant vs IDH-wide type differentiation in low-grade glioma, (2) CT radiomics for COVID-19 vs other viral pneumonia differentiation, and (3) MRI radiomics for high-grade glioma vs brain metastasis differentiation.ConclusionsThe systematic reviews on radiomics were with suboptimal quality. A limited number of radiomics approaches were supported by convincing level of evidence.Clinical relevance statementThe evidence supporting the clinical application of radiomics are insufficient, calling for researches translating radiomics from an academic tool to a practicable adjunct towards clinical deployment.Graphical

An overview of interventions used across the life span to support transitions of those with a neurological condition: A systematic review of reviews

Objectives To systematically appraise published reviews on interventions used to support transitions for individuals with neurological conditions. Data sources MEDLINE, CINAHL, The Allied and Complementary Medicine, AMED, PsycINFO, Cochrane database of systematic reviews and Web of Science were searched between 31st December 2010 and 15th September 2022. Method The systematic review followed PRISMA guidelines. The quality and risk of bias were measured using A MeaSurement Tool to Assess systematic Reviews 2 and the Risk Of Bias In Systematic reviews’ tool. All types of reviews which involved participants with neurological conditions were included. Results Seven reviews met the inclusion criteria. A total of 172 studies were included in the reviews. Effectiveness of transition interventions could not be calculated due to the lack of data. The findings suggested that the use of health applications may be beneficial by increasing self-management capabilities and disease knowledge. Education and clear communication between healthcare providers and recipients may also have positive impacts on quality of life. Risk of bias was found to be high in four of the reviews. Four reviews had low or critically low levels of evidence. Conclusions There is a paucity of published evidence on interventions used to support the transitions of individuals with neurological conditions and the effect that these have on quality of life.

Artificial Intelligence in Head and Neck Cancer: A Systematic Review of Systematic Reviews.

Several studies have emphasized the potential of artificial intelligence (AI) and its subfields, such as machine learning (ML), as emerging and feasible approaches to optimize patient care in oncology. As a result, clinicians and decision-makers are faced with a plethora of reviews regarding the state of the art of applications of AI for head and neck cancer (HNC) management. This article provides an analysis of systematic reviews on the current status, and of the limitations of the application of AI/ML as adjunctive decision-making tools in HNC management. Electronic databases (PubMed, Medline via Ovid, Scopus, and Web of Science) were searched from inception until November 30, 2022. The study selection, searching and screening processes, inclusion, and exclusion criteria followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A risk of bias assessment was conducted using a tailored and modified version of the Assessment of Systematic Review (AMSTAR-2) tool and quality assessment using the Risk of Bias in Systematic Reviews (ROBIS) guidelines. Of the 137 search hits retrieved, 17 fulfilled the inclusion criteria. This analysis of systematic reviews revealed that the application of AI/ML as a decision aid in HNC management can be thematized as follows: (1) detection of precancerous and cancerous lesions within histopathologic slides; (2) prediction of the histopathologic nature of a given lesion from various sources of medical imaging; (3) prognostication; (4) extraction of pathological findings from imaging; and (5) different applications in radiation oncology. In addition, the challenges in implementation of AI/ML models for clinical evaluations include the lack of standardized methodological guidelines for the collection of clinical images, development of these models, reporting of their performance, external validation procedures, and regulatory frameworks. At present, there is a paucity of evidence to suggest the adoption of these models in clinical practice due to the aforementioned limitations. Therefore, this manuscript highlights the need for development of standardized guidelines to facilitate the adoption and implementation of these models in the daily clinical practice. In addition, adequately powered, prospective, randomized controlled trials are urgently needed to further assess the potential of AI/ML models in real-world clinical settings for the management of HNC.

Is valve-sparing aortic root replacement better than total aortic root replacement? Anoverview of reviews.

Total aortic root replacement (TRR) is certainly beneficial for aortic root disease, but does it still have an advantageous prognosis for patients compared to valve-sparing aortic root replacement (VSRR)? An overview of reviews was conducted to assess each of their clinical efficacy/effectiveness. Systematic reviews (SRs)/Meta-analyses comparing the prognosis of TRR and VSRR in aortic root surgery were collected from 4 databases, all searched from the time of database creation to October 2022. Two evaluators independently screened the literature, extracted information and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) tool, Grading of Recommendations, Assessment, Development and Evaluations (GRADE), and Risk of Bias in Systematic Reviews (ROBIS) to evaluate the quality of reporting, methodological quality, risk of bias, and level of evidence of the included studies. A total of 9 SRs/Meta-analyses were ultimately included. In terms of the reporting quality of the included studies, PRISMA scores ranged from 14 to 22.5, with issues mainly in reporting bias assessment, risk of study bias, credibility of evidence, protocol and registration, and funding sources. The methodological quality of the included SRs/Meta-analyses was generally low, with key items 2, 7, and 13 having major flaws and non-key items 10, 12, and 16. In terms of risk of bias assessment, the overall assessment of the included 9 studies was high-risk. The quality of the evidence was rated as low to very low quality for the three outcome indicators selected for the GRADE quality of evidence rating: early (within 30 days postoperatively or during hospitalization) mortality, late mortality, and valve reintervention rate. VSRR has many benefits including reduced early and late mortality after aortic root surgery and reduced rates of valve-related adverse events, but the methodological quality of the relevant studies is low, and there is a lack of high-quality evidence to support this. https://www.PROSPERO, identifier: CRD42022381330.

Efficacy of Surgical Masks Versus N95 Respirators for the Prevention of COVID-19 in Dental Settings: A Systematic Review.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2). It spreads mainly through saliva droplets or nasal discharge. Dentists are among the professionals with the greatestrisk of contracting and transmitting COVID-19. We compared the efficacy of surgical masks versus N95 respirators in preventing COVID-19 infection in dental settings. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched. Search terms corresponded to a predefined PICOS (patient/population, intervention, comparison, and outcomes) question. The risk of bias was evaluated using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2), ROBIS (Risk of Bias in Systematic Reviews), and Health Evidence tools. A total of 191 articles were screened, and nine of them were further evaluated for eligibility, of which five articles (fulfilled the selection criteria) and were included in this study. Two studies concluded that surgical masks could provide equivalent protection to N95 respirators. Another study found that N95 respirators were superior to surgical masks. The fourth study found that better protection can be achieved when using surgical masks by the aerosol source than when the recipient uses an N95 respirator, while the last study concluded that surgical masks or N95 respirators alone do not provide full protection. Thus, according to this systematic review, N95 respirators provide better protection against COVID-19 infection compared to surgical masks.

Exergaming in the treatment of gait, balance, and quality of life in Parkinson's disease: Overview of systematic reviews.

Postural instability and gait impairments are common in people with PD, both of which have a negative effect on their quality of life. Systematic reviews have demonstrated benefits of using exergaming in enhancing these outcomes. However, there is no consensus over whether exergaming therapy is better than conventional physical therapy for enhancing gait, balance, and quality of life. The aim of this overview is to systematically synthesize and evaluate the available evidence found in published systematic reviews and meta-analyses, on the effects of exergaming therapy on balance, gait, and quality of life, compared to conventional physical therapy or no intervention. This overview was reported in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). A comprehensive search was carried out in nine databases. Two reviewers independently extracted data using a standardized forms and the search strategy included terms related to intervention, population, and study type. The methodological quality of the included systematic reviews/meta-analysis (SRs/Mas) was evaluated using the "A Measurement Tool to Assess Systematic Reviews 2" (AMSTAR-2). The "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) was used to assess the quality of the evidence. The risk of bias assessment was performed using the "Risk Of Bias In Systematic Reviews" (ROBIS). PROSPERO registration number: CRD42021238131. 112 SRs/MAs were found and nine of them were selected. Six reviews were rated as very low methodological quality and three reviews as low methodological quality. Five reviews were classified with low risk of bias and four reviews with high risk of bias. Most of the SR/MAs demonstrated significant effects on balance favoring exergaming therapy over conventional therapy, however those studies had been rated as very low quality of evidence. Inconclusive results were found for the quality of life and gait outcomes. Exergaming therapy shows promise for the rehabilitation of PD. However, this overview was unable to conclude with certainty that exergaming therapy is superior to conventional physical therapy in improving gait, balance, or quality of life in people with PD. The effectiveness of exergaming therapy in the treatment of people with PD still need to be verified by high-quality studies.

Reporting quality and risk of bias of Cochrane individual participant data meta-analyses: A cross-sectional study.

This study aimed to assess the reporting quality and risk of bias of Cochrane individual participant data meta-analyses (IPD-MAs). We searched the Cochrane Library and identified the Cochrane IPD-MAs. We used the Preferred Reporting Items for Systematic Review and Meta-Analyses of individual participant data (PRISMA-IPD) assessed the reporting quality of included Cochrane IPD-MAs,and the Risk Of Bias In Systematic reviews (ROBIS) tool was used to assess the risk of bias. We performed stratified and correlation analyses to explore factors affecting the quality. Forty-six Cochrane IPD-MAs were included in our study. Twenty-six Cochrane IPD-MAs (56.5%) had statistical or epidemiological authors involved, and 31 (67.4%) contained only IPD data. Thirty-five studies (76.1%) did not report whether they used 1-stage or 2-stage methods, and forty (87.0%) did not report the statistical techniques used for missing participant data. We found that the entire compliance reported PRISMA-IPD items of Cochrane IPD-MAs published after 2015 (n=18; Mean±SD: 26.61±2.75) was higher than those studies published in 2015 and before (n=28; Mean±SD: 22.61±4.73), the difference was statistically significant (p=0.002). A strong positive correlation was found between the fully reported PRISMA-IPD items and fully accordance ROBIS items (Spearman's: ρ=0.653, p<0.001). The quality of Cochrane IPD-MAs is not high, especially in the reporting of statistical methods. There was room for further improvement in IPD retrieval, IPD integrity and statistical analyses.

Risk factors of breast cancer-related lymphoedema: protocol of an umbrella review

IntroductionBreast cancer-related lymphoedema (BCRL) is a progressive and debilitating complication post-breast cancer treatment. Identifying potential risk factors facilitates the prevention and management of BCRL. Multiple systematic reviews have been conducted...

Effectiveness and safety of manual therapy for knee osteoarthritis: An overview of systematic reviews and meta-analyses.

Manual therapy has been used as an alternative approach to treat knee osteoarthritis (KOA) for many years. Numerous systematic reviews (SRs) or meta-analyses (MAs) were published to evaluate its effectiveness and safety. Nevertheless, the conclusions of SRs/MAs are inconsistent, and the uneven quality needs to be critically appraised. To conduct a comprehensive overview of the effectiveness and safety of manual therapy for KOA and the quality of relevant SRs/MAs, thus providing critical evidence and valuable direction for future researchers to promote the generation of advanced evidence. The pre-defined search strategies were applied to eight electronic databases from inception to September 2022. Suitable SRs/MAs were included in accordance with the inclusion and exclusion criteria. The methodological quality, risk of bias, reporting quality, and evidence quality were assessed by two independent reviewers who used respectively the A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic Reviews (ROBIS), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Version (PRISMA 2020), and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) based on the method of narrative synthesis. We excluded the overlapping randomized controlled trials (RCTs) and performed a re-meta-analysis of the total effective rate. A total of eleven relevant SRs/MAs were included: nine SRs/MAs were rated critically low quality, and two were rated low quality by AMSTAR-2. According to ROBIS, all SRs/MAs were rated low risk in Phase 1 (assessing relevance) and Domain 1 (study eligibility criteria) of Phase 2. Three SRs/MAs (27.27%) were rated low risk in Domain 2 (identification and selection of studies). Ten SRs/MAs (90.91%) were rated low risk in Domain 3 (data collection and study appraisal). Five SRs/MAs (45.45%) were rated low risk in Domain 4 (synthesis and findings). And five SRs/MAs (45.45%) were rated low risk in Phase 3 (risk of bias in the review). By PRISMA 2020, there were some reporting deficiencies in the aspects of abstract (2/11, 18.18%), search strategy (0/11, 0%), preprocessing of merging data (0/11, 0%), heterogeneity exploration (6/11, 54.55%), sensitivity analysis (4/11, 36.36%), publication bias (5/11, 45.45%), evidence quality (3/11, 27.27%), the list of excluded references (3/11, 27.27%), protocol and registration (1/11, 9.09%), funding (1/11, 9.09%), conflict of interest (3/11, 27.27%), and approach to relevant information (0/11, 0%). In GRADE, the evidence quality was defined as moderate quality (8 items, 21.05%), low quality (16 items, 42.11%), and critically low quality (14 items, 36.84%). Among the downgraded factors, risk of bias, inconsistency, imprecision, and publication bias were the main factors. A re-meta-analysis revealed that manual therapy can increase the total effective rate in KOA patients (risk ratio = 1.15, 95% confidence interval [1.12, 1.18], p < 0.00001; I2 = 0, p = 0.84). There are four reviews that narratively report adverse effects, and no severe adverse reactions occurred in the manual therapy group. Manual therapy may be clinically effective and safe for patients with KOA. However, this conclusion must be interpreted with caution because of the generally unsatisfactory study quality and inconsistent conclusions of the included SRs/MAs. Further rigorous and normative SRs/MAs are expected to be carried out to provide robust evidence for definitive conclusions. https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: CRD42022364672.

Health and nutrition claims for infant formula: international cross sectional survey

ObjectivesTo review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims.DesignInternational cross sectional survey.SettingPublic...

Reporting quality and risk of bias in JBI systematic reviews evaluating the effectiveness of interventions: a methodological review protocol.

The objective of this methodological review is to evaluate the adherence of systematic reviews of effectiveness published in JBI Evidence Synthesis to reporting guidelines and methodological quality. Systematic reviews of effectiveness are essential tools for health practitioners and policy-makers. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and the Risk of Bias in Systematic Reviews (ROBIS) tool are used to ensure maintenance of high reporting standards and methodological quality, respectively. This review will utilize these tools to identify strengths and shortfalls in the reporting quality of JBI systematic reviews of effectiveness. This review will include the 20 most recent systematic reviews of effectiveness published in JBI Evidence Synthesis . This review will search MEDLINE (PubMed) for effectiveness reviews published in JBI Evidence Synthesis . Abstract and full-text screening will be performed by 2 independent reviewers, and the most recent 20 studies will be selected for inclusion. Data regarding adherence to PRISMA 2020 and ROBIS will be extracted by 2 independent reviewers. Data will be presented descriptively with tables and synthesized narratively.

Phosphodiesterase type 5 inhibitors and premature ejaculation: an overview of systematic reviews/meta-analyses using the AMSTAR 2, ROBIS, and GRADE tools

Abstract Introduction The place of phosphodiesterase type 5 inhibitors (PDE5-Is) in treating premature ejaculation (PE) remains a therapeutic challenge. Objectives (1) To summarize the evidence of the efficacy and safety of PDE5-Is from published systematic reviews/meta-analyses (SRs/MAs). (2) To evaluate the reporting, methodological quality, and evidence quality of SRs/MAs concerning PE. Methods Nine databases were searched to retrieve SRs/MAs on using PDE5-Is for PE from inception to July 2022. Methodological quality and risk of bias were assessed with the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) and ROBIS (Risk of Bias in Systematic Reviews). GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluations) were used to assess the evidence quality. Results The literature search revealed 15 relevant SRs/MAs covering 28 primary studies (9 pairwise MAs and 6 network MAs) rated as low or very low quality and high risk of bias except 1 review that was rated as moderate quality and low risk of bias. Among the 27 outcome measures related to efficacy and safety, the quality of evidence according to GRADE criteria was low in 4 and critically low in 23. Oral PDE5-Is have demonstrated a possible benefit over placebo in lifelong PE and mixed PE. The results of pairwise and network MAs advocated that the combined use of PDE5-Is and SSRIs is of possible benefit as compared with either SSRIs or PDE5-Is alone. The total adverse effects were more frequent with PDE5-Is than placebo. Conclusion PDE5-Is are of a possible benefit than placebo in lifelong PE and mixed PE. The results favor coadministration of PDE5-Is plus SSRIs over SSRIs alone or PDE5-I monotherapy. These conclusions should be interpreted cautiously due to the low methodological quality and low quality of evidence of most available reviews. Additional higher-quality randomized controlled trials, SRs, and MAs are warranted to provide a better estimate of any effect size.

An Overview of Systematic Reviews and Meta-Analyses of Clinical Studies of Acupuncture for Cancer Pain.

Systematic reviews (SRs) and meta-analyses (MAs) for the use of acupuncture for cancer pain have been increasing, but the evidence has not been systematically and comprehensively assessed. We aimed to perform an overview of the evidence quality of SRs/MAs of acupuncture for improving cancer pain. 8 databases were systematically searched to identify SRs/MAs of acupuncture for improving cancer pain. The A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grades of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively, were applied by 2 independent reviewers to evaluate the methodological quality, risk of bias, reporting quality, and evidence quality. A total of 14 SRs/MAs were included in the present study. By AMSTAR-2, two reviews were rated as having high methodological quality, while 12 were given a critically low rating. All SRs/MAs in Phase 1, Domain 1, and Domain 4, according to ROBIS, were at low risk. Furthermore, 4 reviews in Domain 2, twelve reviews in Domain 3, and ten SRs/MAs in Phase 3, were rated as having low risk of bias. With reporting quality, some reporting flaws were identified in the topic of protocol and registration, additional analyses, and search strategy. According to GRADE, the level of evidence quality was "critically low" to "moderate," and risk of bias was the most common downgraded factor. Acupuncture may be beneficial in improving cancer pain. However, due to the identified limitations and inconsistent findings, we recommend further rigorous, and more standardized SRs/MAs to provide strong evidence for definitive conclusions.

The association between dietary sodium intake and obesity in adults by sodium intake assessment methods: a review of systematic reviews and re-meta-analysis.

The scientific evidence of a sodium-obesity association is limited by sodium intake assessments. Our specific aim is to synthesize the association between dietary sodium intake and obesity across the sodium intake assessments as evidenced by systematic reviews in adults. A systematic search identified systematic reviews comparing the association of dietary sodium intakes with obesity-related outcomes such as body mass index (BMI), body weight, waist circumference, and risk of (abdominal) obesity. We searched PubMed on October 24, 2022. To assess the Risk of Bias in Systematic Reviews (ROBIS), we employed the ROBIS tool. This review included 3 systematic reviews, consisting of 39 unique observational studies (35 cross-sectional studies and 4 longitudinal studies) and 15 randomized controlled trials (RCTs). We found consistently positive associations between dietary sodium intake and obesity-related outcomes in cross-sectional studies. Studies that used 24-h urine collection indicated a greater BMI for those with higher sodium intake (mean difference = 2.27 kg/m2; 95% confidence interval [CI], 1.59-2.51; P < 0.001; I2 = 77%) compared to studies that used spot urine (mean difference = 1.34 kg/m2; 95% CI, 1.13-1.55; P < 0.001; I2 = 95%) and dietary methods (mean difference = 0.85 kg/m2; 95% CI, 0.1-1.51; P < 0.05; I2 = 95%). Quantitative synthesis of the systematic reviews has shown that cross-sectional associations between dietary sodium intake and obesity outcomes were substantially different across the sodium intake assessments. We need more high-quality prospective cohort studies and RCTs using 24-h urine collection to examine the causal effects of sodium intake on obesity.

Effectiveness and safety of acupuncture for children with cerebral palsy: An overview of systematic reviews

: Evidence on the effectiveness and safety of acupuncture for cerebral palsy (CP) is inconsistent, and methodological quality has not been comprehensively assessed in systematic reviews (SRs) or meta-analyses (MAs). This overview aims to integrate the evidence from SRs, summarize the safety issues, and comprehensively assess the methodological quality. : 11 databases were searched for SRs/MAs. Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) was used to evaluate the methodological quality of the included SRs. The quality of the reporting was determined according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of acupuncture (PRISMA-A). Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was applied to assess the quality of evidence for the primary outcomes. Risk of Bias in Systematic Reviews (ROBIS) evaluated the risk of bias of included SRs. Network meta-analysis(NMA) for comparing the relative effectiveness of different acupuncture treatments for CP. : 9 SRs/MAs included 107 randomized controlled trials (RCTs) with 9744 patients. Evidence suggests that acupuncture can increase the total effective rate and improve motor function, independence, and activities of daily living without serious adverse events. NMA indicated that needle acupuncture showed a slight statistical difference in improving the overall effectiveness of CP. : Evidence from SRs and NMA suggests that acupuncture for CP is promising and safe. Needle acupuncture is expected to be the best treatment for CP; however, the clinical differences may not be significant. The low methodological quality and the slight overlap of SRs limit the conclusions of this overview. 1 1 1. AMSTAR-2: Assessing the Methodological Quality of Systematic Reviews 2 2. PRISMA-A: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses of acupuncture 3. GRADE: Grading of Recommendations Assessment, Development, and Evaluation 4. ROBIS: Risk of Bias in Systematic Reviews 5. CP: Cerebral palsy 6. SRs: Systematic reviews 7. MAs: Meta-analysis 8. SCPE: The Surveillance of Cerebral Palsy in Europe 9. RCTs: Randomized controlled trials 10. EBM: Evidence-based medicine 11. GMFM: Gross Motor Function Scale 12. MAS: Modified Ashworth Scale 13. ADL: Activities of Daily Living Scale 14. CFADC: Comprehensive Function Assessment for Disabled Children 15. NMA: Network meta-analysis 16. CCA: Corrected covered area 17. IF: Inconsistency factors 18. SMD: Standardized Mean Difference 19. WMD: Weighted Mean Difference 20: OR: Odds ratio 21. RR: Relative risk 22. CI: 95% credible intervals

Breathing Exercises in the Treatment of COPD: An Overview of Systematic Reviews.

The effectiveness of breathing exercises in the treatment of chronic obstructive pulmonary disease (COPD) has been demonstrated in several systematic reviews (SRs), but a comprehensive review is still lacking. The aim of this study was to synthesize evidence from SRs, to summarise the effects of breathing exercises interventions for COPD patients. We conducted an overview of the SRs of breathing exercises in the treatment of COPD. We include Systematic Reviews of randomized-controlled clinical trials. In the included COPD, control of breathing exercises alone was the only variable and no restriction was placed on relevant outcome measures. The SRs were screened by computer retrieval from the Chinese National Knowledge Infrastructure (CNKI), WanFang database, Chinese Science and Technology Journal Database (CSTJ), Chinese Biological Medicine (CBM), MEDLINE (PubMed), Embase, Cochrane library, and Web of Science. The Risk of Bias in Systematic reviews (ROBIS) tool, the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement, a Measure Tool to Assess Systematic Reviews (AMSTAR) 2, and the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) were used to evaluate the risk of bias, reporting quality, methodology quality, and evidence quality. Nine SRs met the inclusion criteria and were included in the overview, 4 SRs in Chinese, and 3 SRs in English. All the SRs were published between 2015-2021. According to the ROBIS tool, 4 SRs (57.14%) were rated as low risk of bias. The PRISMA scale showed that 5 SRs had some defects, and 2 SRs were relatively complete. Reporting deficiencies exist primarily in protocol and registration (28.6%), search (42.9%), risk of bias across studies (0%), additional analyses (42.9%), and funding (28.6%). Based on the AMSTAR-2 scale, 3 SRs were low quality, and the other 4 SRs were very low. The result of evidence quality assessment showed that among the 34 outcomes involved in the 7 studies, 19 were low-level outcomes, 15 were very low-level outcomes, and there were no moderate and high-level quality outcomes. Limitations and publication bias were two major factors that reduced the quality of evidence. Breathing exercises in certain can improve pulmonary function, exercise endurance, dyspnea, quality of life, and respiratory muscle strength of COPD patients. However, there is an urgent need for high-quality studies to guide clinical practice due to certain deficiencies in reporting quality and the low quality of methodology and outcomes.

Acupuncture and Related Therapies for Chronic Urticaria: A Critical Overview of Systematic Reviews.

Chronic urticaria (CU) can severely impair the quality of life. Acupuncture and related therapies have been widely used in the treatment of CU in China. This study aimed to summarize and critically evaluate the methodological and reporting quality of relevant systematic reviews (SRs) and present objective and comprehensive evidence on the effectiveness and safety of acupuncture and related therapies for CU. Eight electronic databases were searched from inception to October 2021 for SRs examining acupuncture and related therapies for CU, and gray literature was manually searched. Two authors independently identified SRs and extracted data. The methodological and reporting quality of these SRs were assessed by the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool and preferred reporting items for SRs and meta-analyses (PRISMA, 2020), respectively. In addition, the risk of bias in systematic reviews (ROBIS) was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was applied to evaluate the quality of evidence for outcome measures. In total, 23 SRs, including a total of 11 outcome indicators, were published before October 2021. The AMSTAR-2 results showed that the methodological quality of all SRs was critically low; items 2, 3, 7, 9, 10, and 16 were found to have particularly low quality. For PRISMA, the reporting quality of the included SRs was unsatisfactory, and major reporting flaws were observed in the search strategy, synthesis method, certainly assessment, reporting biases, registrations, and financial support of the included SRs. For ROBIS, 22 SRs (95.65%) had a high risk of bias. Among the 55 outcomes assessed using the GRADE framework, there were 3 (5.45%) outcomes with moderate-quality evidence, 6 (10.91%) outcomes with low-quality evidence, and 46 (83.64%) outcomes with very low-quality evidence. We found the moderate quality of evidence indicating that the total effective rate and curing rate of the acupuncture group were higher than those of the western medicine group, and the recurrence rate was lower than that of the western medicine group. Acupuncture and related therapies for the treatment of CU are supported by low-quality evidence-based medicine. However, considering the poor quality of these SRs, we suggest that studies with more rigorous designs, larger sample sizes, and higher methodological and reporting quality are necessary to provide stronger evidence. Registration. The protocol for this study has been registered (PROSPERO registration number: CRD42021259131).

Reporting Bias in Systematic Reviews and Meta-Analyses Related to the Treatment of Distal Radius Fractures: The Presence of Spin in the Abstract.

Spin is a form of reporting bias which suggests a treatment is beneficial despite a statistically nonsignificant difference in outcomes. Our purpose was to define the prevalence of spin within the abstracts of distal radius fracture (DRF) systematic reviews (SRs) and meta-analyses (MA). We also sought to identify article characteristics that were more likely to contain spin. We performed a SR of multiple databases to identify DRF SRs and MAs. Articles were screened and analyzed by 3 reviewers. We recorded article and journal characteristics including adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, funding disclosures, methodologic quality (AMSTAR 2 instrument), impact factor, and country of origin. Presence of the 9 most severe types of spin in abstracts were recorded. Unadjusted odds ratios (ORs) were calculated to analyze the association between article characteristics and the presence of spin. A total of 112 articles were included. Spin was present in 46% of abstracts, with type 1 spin ("conclusions not supported by findings") most frequent (19%). Spin was present in 43% of abstracts in PRISMA-adhering journals compared to 49% in journals that did not (OR = 0.79, 95% confidence interval [CI] = 0.37-1.68). For articles originating from China, spin was present in 61% of abstracts compared to 39% of abstracts from other countries (OR = 2.55, 95% CI = 1.13-5.75). In addition to low article quality, there are high rates of spin within the abstracts of SRs and MAs related to treatment of DRF. Articles within journals that adhere to PRISMA do not appear to contain less spin.