Quality Appraisal Criteria Research Articles

The incidence of cardiovascular disease, cancer and type 2 diabetes comorbidities in HIV infection: A systematic review

Introduction: Epidemiological linkages between HIV/AIDS and common Noncommunicable diseases are established. However, the incidence of these diseases among people living with HIV is not well examined. Objectives: To describe the incidence of cardiovascular diseases, cancers, and type 2 diabetes among people living with HIV. Methods: We have conducted a systematic review of incidence studies. Studies reporting on the incidence of cardio- vascular diseases, cancers and type 2 diabetes among People living with HIV were retrieved from Embase and Medline databases. We used explicit eligibility and quality appraisal criteria to screen and select studies. We extracted study characteristics, outcome values and key conclusions. Findings were reported using tables and narrative summaries. Results: A total of 30 studies were included in this systematic review. The incidence of cardiovascular diseases, cancers, and type 2 Diabetes comorbidities among people living with HIV was found to range from 1.19 to 11.3, 6.63 to 43.77, and 4.42 to 36.26 per 1000 person years, respectively. HIV infection was associated with increased risk of cardiovascular diseases and cancers. Specific types of antiretroviral drugs and longer duration of antiretroviral treatment were among the determinants of cardiovascular diseases and type 2 Diabetes in HIV infection. While the introduction of antiretroviral treatment was followed by a rapid decline in the incidence of AIDS-defining cancers, its effect on the incidence of non-AIDS defining cancers looks minimal. Conclusion: The current evidence suggests that policies and interventions targeting people living with HIV should prioritize the prevention of the risk of common Noncommunicable diseases together with the rapid scale up of HIV treatment.

Association of Interleukin-10–1082 Promoter Polymorphism with Gastric Cancer: Appraisal of a Recent Meta-Analysis

Dear Editor: I read with a great interest the recent article by Ni et al. (2012). They performed a meta-analysis of 20 case–control studies to explore the role of allele A/G single-nucleotide polymorphism of the gene interleukin-10 (IL-10) promoter-1082 in the susceptibility to gastric cancer. Their meta-analysis suggests that IL-10-1082 GG-plus-GA genotypes are associated with the overall risk of developing gastric cancer and seem to be more susceptible to overall gastric cancer in Asian populations. IL-10-1082 GG-plus-GA genotypes are more associated with the pathologically intestinal-type gastric cancer or anatomically cardia-type gastric cancer. It is an interesting study. Nevertheless, I would like to raise several concerns related to this article. First, in the introduction, they stated that “Interestingly, the IL-10-1082 AA genotype was also reported to be significantly increased in prostate cancer patients. …” Recently, we performed a meta-analysis of 13 studies (5503 cases and 6078 controls) to examine the association between IL-10 gene polymorphisms and prostate cancer (PCa), and the results suggest that there is no association between the IL-10-1082 G/A promoter polymorphism and PCa (Zou et al., 2011). Therefore, evidence from previous studies does not support the authors' statement. Second, it seems unreasonable for authors to select an eligible study. In the meta-analysis, there were two studies by Wu et al. (2002, 2003) from the same population. In the two studies, a part of subjects were recruited from the National Taiwan University Hospital (Taipei). Thus, the two studies may contain overlapping data, and only the larger study (Wu et al., 2003) should be selected for the analysis. Additionally, in the meta-analysis, two studies (Bai et al., 2008; Zhou et al., 2008) were eliminated because they both described only the number of combined group GG-plus-GA rather than the number of genotype GG and the number of genotype GA, respectively. Although the number of genotype GG and the number of genotype GA were not described in the two studies, it was sufficient for authors to calculate the odds ratio with 95% confidence intervals in the dominant model (GG-plus-GA vs. AA). Thus, the two studies should be included for the analysis. Third, the scale for quality appraisal used in the meta-analysis contains incomplete information, and should be further improved. A common objection to the meta-analysis is that it combines results from studies of disparate quality. To identify high-quality studies, authors adopted predefined criteria for quality appraisal in the meta-analysis. The criteria cover credibility of controls, representativeness of cases, consolidation of gastric cancer, genotyping examination, and association assessment. Criteria for quality appraisal should include those traits or items presumed to predict the accuracy of study results. Unfortunately, the criteria used in the meta-analysis did not include the important information whether cases and controls were matched by age and gender. Lack of matching by age and gender can result in bias in case–control studies. Finally, authors did not solve the problem of multiple comparisons. Numerous comparisons (at least 19) were performed in the meta-analysis, and authors should adjust the significance alpha level to correct for the problem of multiple comparisons. Moreover, authors did many subgroup analyses in the article; however, it seems unnecessary to do some subgroup analyses, such as large sample, small-and-moderate sample, publication before or in 2005, and publication after 2005. Collectively, IL-10-1082 GG-plus-GA genotypes are associated with gastric cancer. We believe that our remarks will contribute to more accurate elaboration of the results presented by Ni et al. (2012).

Genetic parameters of product quality and hepatic metabolism in fattened mule ducks1

Genetic parameters of traits related to hepatic lipid metabolism, carcass composition, and product quality of overfed mule ducks were estimated on both parental lines of this hybrid: the common duck line for the maternal side and the Muscovy line for the paternal side. The originality of the statistical model was to include simultaneously the additive genetic effect of the common ducks and that of the Muscovy ducks, revealing a greater genetic determinism in common than in Muscovy. Plasma metabolic indicators (glucose, triglyceride, and cholesterol contents) were heritable, in particular at the end of the overfeeding period, and heritabilities increased with the overfeeding stage. Carcass composition traits were highly heritable in the common line, with values ranging from 0.15 for liver weight, 0.21 for carcass weight, and 0.25 for abdominal fat weight to 0.32 for breast muscle weight. Heritabilities of technological outputs were greater for the fatty liver (0.19 and 0.08, respectively, on common and Muscovy sides for liver melting rate) than for the pectoralis major muscle (between 0.02 and 0.05 on both parental sides for cooking losses). Fortunately, the processing industry is mainly facing problems in liver quality, such as too high of a melting rate, than in meat quality. The meat quality appraisal criteria (such as texture and cooking losses), usually dependent on pH and the rate of decline of pH, were also very lowly heritable. This study demonstrated that genetic determinism of meat quality and ability of overfeeding is not similar in the common population and in the Muscovy population; traits related to fattening, muscle development, and BW have heritability values from 2 to 4 times greater on the common line than on the Muscovy line, which is relevant for considering different selection strategies.

Information from Pharmaceutical Companies and the Quality, Quantity, and Cost of Physicians' Prescribing: A Systematic Review

Pharmaceutical companies spent $57.5 billion on pharmaceutical promotion in the United States in 2004. The industry claims that promotion provides scientific and educational information to physicians. While some evidence indicates that promotion may adversely influence prescribing, physicians hold a wide range of views about pharmaceutical promotion. The objective of this review is to examine the relationship between exposure to information from pharmaceutical companies and the quality, quantity, and cost of physicians' prescribing. We searched for studies of physicians with prescribing rights who were exposed to information from pharmaceutical companies (promotional or otherwise). Exposures included pharmaceutical sales representative visits, journal advertisements, attendance at pharmaceutical sponsored meetings, mailed information, prescribing software, and participation in sponsored clinical trials. The outcomes measured were quality, quantity, and cost of physicians' prescribing. We searched Medline (1966 to February 2008), International Pharmaceutical Abstracts (1970 to February 2008), Embase (1997 to February 2008), Current Contents (2001 to 2008), and Central (The Cochrane Library Issue 3, 2007) using the search terms developed with an expert librarian. Additionally, we reviewed reference lists and contacted experts and pharmaceutical companies for information. Randomized and observational studies evaluating information from pharmaceutical companies and measures of physicians' prescribing were independently appraised for methodological quality by two authors. Studies were excluded where insufficient study information precluded appraisal. The full text of 255 articles was retrieved from electronic databases (7,185 studies) and other sources (138 studies). Articles were then excluded because they did not fulfil inclusion criteria (179) or quality appraisal criteria (18), leaving 58 included studies with 87 distinct analyses. Data were extracted independently by two authors and a narrative synthesis performed following the MOOSE guidelines. Of the set of studies examining prescribing quality outcomes, five found associations between exposure to pharmaceutical company information and lower quality prescribing, four did not detect an association, and one found associations with lower and higher quality prescribing. 38 included studies found associations between exposure and higher frequency of prescribing and 13 did not detect an association. Five included studies found evidence for association with higher costs, four found no association, and one found an association with lower costs. The narrative synthesis finding of variable results was supported by a meta-analysis of studies of prescribing frequency that found significant heterogeneity. The observational nature of most included studies is the main limitation of this review. With rare exceptions, studies of exposure to information provided directly by pharmaceutical companies have found associations with higher prescribing frequency, higher costs, or lower prescribing quality or have not found significant associations. We did not find evidence of net improvements in prescribing, but the available literature does not exclude the possibility that prescribing may sometimes be improved. Still, we recommend that practitioners follow the precautionary principle and thus avoid exposure to information from pharmaceutical companies. Please see later in the article for the Editors' Summary.

Rhetoric or reality? A systematic review of the impact of participatory approaches by UK public health units on health and social outcomes

There has been a philosophical commitment to participation in public health since the 1970s. UK policy rhetoric on participation in public health has been particularly marked since 1997. It is less clear that participatory approaches have been pursued by UK public health units in practice. A systematic review was undertaken of all studies using any recognized research methodology from 1974 to 2007 reporting on health and social outcomes of participatory approaches by UK public health units. Seventeen electronic databases were searched and inclusion/exclusion criteria and quality appraisal criteria applied. Five thousand and four hundred and fifty-one references were identified, reduced to 2155 once duplicates were removed. Only eight papers covering seven studies were relevant and included in the analysis. Only two studies met more than half of the relevant quality appraisal criteria. The studies fell into two distinct groups: four used qualitative methods to illustrate the complexities of effective community participation; three claimed success for their participative initiative without providing adequate evidence to substantiate such claims. This systematic review demonstrates that there is very little evidence in the peer-reviewed literature of participatory approaches by UK public health units or of such approaches having any noteworthy impact on health and social outcomes.

No good evidence to link toothbrushing trauma to gingival recession

Medline, Embase, Web of Knowledge, the Cochrane Central Register of Controlled Trials, Current Contents Connect and the Google Scholar databases were searched. Searches by hand were also made of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched. Screening of studies was carried out independently by three reviewers and assessed for quality. Studies of Level III, ie, observational studies without control groups (cross sectional studies, before-and-after studies, case series) or better were included. Studies reported in the English, German, Spanish or Greek language were included. Data were extracted from the full-text articles using a purposely designed data extraction form, and a qualitative summary was carried out. Eighteen studies were included. One abstract from the meeting EuroPerio 5 reported a randomised-controlled clinical trial (RCT; Level I evidence) in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over the course of 18 months. Of the remaining 17 observational studies, two concluded there was no apparent relationship between toothbrushing frequency and gingival recession. Eight studies reported a positive association between toothbrushing frequency and recession. Other potential risk factors were duration of toothbrushing, brushing force, and frequency of changing the toothbrush, brush (bristle) hardness and toothbrushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal, and a valid appraisal of the quality of the RCT was not possible. The data to support or refute the association between toothbrushing and gingival recession are inconclusive.

Does tooth brushing influence the development and progression of non‐inflammatory gingival recession? A systematic review

The aim of this systematic review was to produce the best available evidence and pool appropriate data to evaluate the effect of tooth brushing on the initiation and progression of non-inflammatory gingival recession. A protocol was developed a priori for the question: "Do factors associated with tooth brushing predict the development and progression of non-inflammatory gingival recession in adults?" The search covered six electronic databases between January 1966 and July 2005. Hand searching included searches of the Journal of Clinical Periodontology, Journal of Periodontal Research and the Journal of Periodontology. Bibliographies of narrative reviews, conference proceedings and relevant texts known to the authors were also searched. Inclusion of titles, abstracts and ultimately full texts was based on consensus between three reviewers. The full texts of 29 papers were read and 18 texts were eligible for inclusion. One abstract from EuroPerio 5 reported a randomized-controlled clinical trial [Level I evidence] in which the authors concluded that the toothbrushes significantly reduced recessions on buccal tooth surfaces over 18 months. Of the remaining 17 observational studies, two concluded that there appeared to be no relationship between tooth brushing frequency and gingival recession. Eight studies reported a positive association between tooth brushing frequency and recession. Other potential risk factors were duration of tooth brushing, brushing force, frequency of changing the toothbrush, brush (bristle) hardness and tooth brushing technique. None of the observational studies satisfied all the specified criteria for quality appraisal and a valid appraisal of the quality of the randomized-controlled trial was not possible. The data to support or refute the association between tooth brushing and gingival recession are inconclusive.

Timed voiding for the management of urinary incontinence in adults.

Timed voiding is a fixed time interval toileting assistance program that has been promoted for the management of people with urinary incontinence who cannot participate in independent toileting. For this reason, it is commonly assumed to represent current practice in residential aged care settings. To assess the effects of timed voiding for the management of urinary incontinence in adults who cannot participate in independent toileting. We searched the Cochrane Incontinence Group specialised register (9 May 2002), MEDLINE (January 1966 to December 2002), EMBASE (January 1980 to Week 18 2002), CINAHL (January 1982 to February 2001), PsycINFO (January 1972 to current), Biological Abstracts (January 1980 to December 2000), Current Contents (January 1993 to December 2001) and the reference lists of relevant articles. We also contacted experts in the field, searched relevant websites and handsearched journals and conference proceedings. We selected all randomised and quasi-randomised trials that addressed timed voiding in an adult population and that had an alteration in continence status as a primary outcome. We included those trials that had assessed timed voiding delivered either alone or in combination with another intervention and compared it with either usual care, or no timed voiding, or another intervention. Data extraction and quality assessment were undertaken by at least two people working independently of each other. Any differences were resolved by discussion until agreement was reached. The relative risk for dichotomous data were calculated with 95% confidence intervals. Where data were insufficient to support a quantitative analysis, a narrative overview was undertaken. Two trials with a total of 298 participants met the inclusion criteria. Both compared timed voiding plus additional intervention with usual care. In one of these timed voiding was combined with continence products, placement of a bedside commode for each participant, education to staff on transfer techniques, feedback and encouragement to staff, praise to participants for "successful responses" and administration of oxybutynin in small doses. The mean percentage who were incontinent when checked daily was 20% in the intervention group compared with 80% in the control group. No further between group analysis was possible from the data reported. The other trial combined timed voiding with a medical assessment and individualised medical management that was based on clinical data. Reduction in the number of participants with daytime and night-time incontinence was greater in the intervention group but this difference was statistically significant only for night-time wetting. There was no difference in the volume of urine lost as determined by pad weighing. The methodological quality of these trials was not high based on the quality appraisal criteria of the Cochrane Incontinence Group. In particular, there was a lack of clarity regarding levels of blinding. It was not possible to combine data from trials. In both trials, the fixed schedule of toileting was combined with other interventions. The extent to which the results reflect the contribution of timed voiding is unknown because the trials' design did not allow assessment of the effects of the fixed schedule of toileting separately from other components of the interventions. The data were too few and of insufficient quality to provide empirical support for or against the intervention of timed voiding.

The use of quality benchmarking in assessing web resources for the dermatology virtual branch library of the National electronic Library for Health (NeLH).

BackgroundIn 1998, the U.K. National Health Service Information for Health Strategy proposed the implementation of a National electronic Library for Health to provide clinicians, healthcare managers and planners, patients and the public with easy, round the clock access to high quality, up-to-date electronic information on health and healthcare. The Virtual Branch Libraries are among the most important components of the National electronic Library for Health . They aim at creating online knowledge based communities, each concerned with some specific clinical and other health-related topics.ObjectivesThis study is about the envisaged Dermatology Virtual Branch Libraries of the National electronic Library for Health . It aims at selecting suitable dermatology Web resources for inclusion in the forthcoming Virtual Branch Libraries after establishing preliminary quality benchmarking rules for this task. Psoriasis, being a common dermatological condition, has been chosen as a starting point.MethodsBecause quality is a principal concern of the National electronic Library for Health, the study includes a review of the major quality benchmarking systems available today for assessing health-related Web sites. The methodology of developing a quality benchmarking system has been also reviewed. Aided by metasearch Web tools, candidate resources were hand-selected in light of the reviewed benchmarking systems and specific criteria set by the authors.ResultsOver 90 professional and patient-oriented Web resources on psoriasis and dermatology in general are suggested for inclusion in the forthcoming Dermatology Virtual Branch Libraries. The idea of an all-in knowledge-hallmarking instrument for the National electronic Library for Health is also proposed based on the reviewed quality benchmarking systems.ConclusionsSkilled, methodical, organized human reviewing, selection and filtering based on well-defined quality appraisal criteria seems likely to be the key ingredient in the envisaged National electronic Library for Health service. Furthermore, by promoting the application of agreed quality guidelines and codes of ethics by all health information providers and not just within the National electronic Library for Health, the overall quality of the Web will improve with time and the Web will ultimately become a reliable and integral part of the care space.