Evidence Quality Of Outcome Measures Research Articles

Scientific Evidence of Acupuncture for Post-Stroke Cognitive Impairment: An Overview of Systematic Reviews and Meta-Analyses.

Acupuncture may be effective to treat post-stroke cognitive impairment (PSCI). We aimed to evaluate the reliability of the systematic reviews/meta-analyses (SRs/MAs) evidence regarding acupuncture treatment of PSCI. The methodological quality was appraised with Methodological Quality of Systematic Reviews 2 (AMSTAR-2). We evaluated reporting quality with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and evidence quality with Grade of Recommendation, Assessment, Development and Evaluation (GRADE) system. The inclusion criteria were met by fifteen reviews. All studies assessed by AMSTAR-2 had critically poor methodological quality due to the limitations on the lack of the provision of the list of excluded trails, screening of duplicate study, and protocol registration. For reporting quality, response rate of "yes" was less than 50% in Q5 (protocol and registration topic), Q8 (Search) and Q23 (Additional analysis). Evidence quality of outcome measures was low or worse with GRADE because when the data was qualitatively synthesized, low quality and small sample size trials provided the data. Acupuncture may be beneficial for PSCI. Because of limitations and inconsistent conclusions, further research is needed to provide higher evidence for acupuncture on PSCI.

Effectiveness of manual lymphatic drainage for breast cancer-related lymphoedema: an overview of systematic reviews and meta-analyses

There are several studies on the treatment of breast cancer-related lymphedema (BCRL) based on the manual lymphatic drainage (MLD) technique, making it a widely accepted conservative treatment for BCRL. In this study, PubMed, Embase and Cochrane Library databases were searched for systematic reviews (SRs) or meta-analyses (MAs) from inception till 28 March 2022. The methodological quality of the included SRs/MAs was evaluated using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), and the evidence quality of outcome measures using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Grading of Recommendations, Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) was used to describe the certainty of evidence from qualitative data. The study results identified 7 eligible SRs/MAs. Evaluation using AMSTAR-2 revealed only one moderate quality study, while the others were rated as low or critically low. The GRADE criteria identified 3 very-low-quality evidence studies, 1 low-quality evidence study, and 9 moderate-quality evidence studies. The GRADE-CERQual assessment showed the confidence for decision-making was either low or moderate. Overall, the results indicated that MLD could significantly reduce lymphedema in patients aged <60 years (standard mean difference (SMD): −1.77, 95% confidence interval (CI): (−2.23 to −1.31)), and the optimal intervention duration was 1 month. Although MLD for BCRL might reduce lymphoedema volume, their effects were not well established, and therefore, we could not recommend the addition of MLD to complete decongestive therapy (CDT) or compression therapy for patients with BCRL. Thus, MLD treatment appeared to be an ambiguous but potentially effective BCRL treatment. Rigorously designed high-quality randomized controlled trials with larger sample sizes are needed to further verify the effectiveness of MLD therapy in BCRL treatment.

Efficacy of melanoma patients treated with PD-1 inhibitors: Protocol for an overview, and a network meta-analysis of randomized controlled trials.

Melanoma is a malignant tumor of melanocytes that produces pigments and can occur in the whole body. It is characterized by strong invasiveness, high metastasis rate and poor prognosis, and brings heavy burden to patients and society. In order to find the most effective and safe treatment measures, in this study, a network meta-analysis (NMA) for randomized controlled trials (RCTs) of advanced melanoma treated with PD-1 inhibitors will be conducted based on the existing systematic reviews (SRs) of PD-1 inhibitor in the treatment of advanced melanoma. PubMed, EMBASE, Web of Science and the Cochrane Library were searched on December 18, 2018 to obtain systematic reviews of PD-1 inhibitor in the treatment of advanced melanoma. Assessing the Methodological Quality of Systematic Reviews (AMSTAR2) will be used to assess the methodological quality of systematic reviews, Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be applied to evaluate the evidence quality of outcome measures, and the Cochrane's risk of bias tool will be utilized to appraise risks of bias of each embedded RCTs. And the outcomes are overall survival (OS), progression-free survival (PFS) and objective response rate (ORR). Hazard ratio (HR) or odds ratio (OR) with their 95% confidence interval (CI) were used to synthesize dichotomous outcomes, while the mean difference (MD) for the continuous variables. R3.5.1 will be used to create a network evidence map for direct and indirect comparative analysis. This study will provide a comprehensive summary of the current evidences related to the efficacy and safety of PD-1 inhibitor in advanced melanoma. Our findings will be useful to assist clinicians make reasonable decisions to the treatment of advanced melanoma. It is unnecessary for this NMA to acquire an ethical approval, because it is based on published researches. CRD42019120017.