Quality Of Reporting Of Meta-analyses Research Articles

Cemented vs Uncemented hemiarthroplasties for femoral neck fractures: An overlapping systematic review and evidence appraisal.

The purpose of our study is to assess the methodology of overlapping systematic reviews related to cemented vs uncemented hip hemiarthroplasties for the treatment of femoral neck fractures to find the study with the best evidence. Also, we assess the gaps in methodology and information to help with direction of future studies. A systematic search was conducted in September 2022 using Pubmed, Embase, and Cochrane Library. Clinical outcome data and characteristics of each study were extracted to see which treatment had better favorability. The outcomes and characteristics extracted from each study includes, first author, search date, publication journal and date, number of studies included, databases, level of evidence, software used, subgroup analyses that were conducted, and heterogeneity with the use of I2 statistics Methodological quality information was extracted from each study using four different methodologic scores (Oxford Levels of Evidence; Assessment of Multiple Systematic Reviews (AMSTAR); Quality of reporting of meta-analyses (QUROM); Oxman and Guyatt. After that, the Jadad decision algorithm was used to identify which studies in our sample contained the best available evidence. Finally, overlap of each systematic review was assessed using Corrected Covered Area (CCA) to look at redundancy and research waste among the systematic reviews published on the topic. After screening, 12 studies were included in our sample. For the Oxford Levels of Evidence, we found that all the studies were Level I evidence. For the QUORUM assessment, we had 1 study with the highest score of 18. Additionally, we did the Oxman and Guyatt assessment, where we found 4 studies with a maximum score of 6. Finally, we did an AMSTAR assessment and found 2 studies with a score of 9. After conducting the methodological scores; the authors determined that Li. L et al 2021 had the highest quality. In addition, it was found that the CCA found among the primary studies in each systematic review calculated to .22. Any CCA above .15 is considered "very high overlap". The best available evidence suggests that Cemented HAs are better at preventing Prosthesis-related complications. Conversely, the best evidence also suggests that Cemented HA also results in longer operative time and increased intraoperative blood loss. When conducting future systematic reviews related to the topic, we ask that authors restrict conducting another systematic review until new evidence emerges so as not to confuse the clinical decision-making of physicians.

An Evaluation of Reporting Guidelines and Clinical Trial Registry Requirements Among Addiction Medicine Journals.

Robust methodology and ethical reporting are paramount for quality scientific research, but recently, that quality in addiction research has been questioned. Avenues to improve such research quality include adherence to reporting guidelines and proper usage of clinical trial registries. Reporting guidelines and clinical trial registries have been shown to lead researchers to more ethical and transparent methodology. To investigate the reporting guideline and clinical trial registration policies of addiction research journals and identify areas of improvement. We used Google Scholar Metrics' h-5 index to identify the top 20 addiction research journals. We then examined the instructions for authors from each journal to identify whether they required, recommended, or made no mention of trial registration and reporting guidelines, including the Consolidated Standards of Reporting Trials (CONSORT), Meta-Analysis of Observational Studies in Epidemiology (MOOSE), Quality of Reporting of Meta-analyses (QUOROM), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Standards for Reporting Diagnostic Accuracy Studies (STARD), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), Animal Research: Reporting of In Vivo Experiments (ARRIVE), Case Reports (CARE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), Standards for Reporting Qualitative Research (SRQR), Standards for Quality Improvement Reporting Excellence (SQUIRE), Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT), Consolidated Criteria for Reporting Qualitative Research (COREQ), Transparent Reporting of a Multivariate Prediction Model for Individual Prognosis or Diagnosis (TRIPOD), Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), and the International Committee of Medical Journal Editors (ICMJE) guidelines. We performed the same analysis regarding requirements for clinical trial registration. Of the 20 journals included in this study, 10 journals (50%) did not require adherence to any reporting guidelines. Trial registration followed a similar trend; 15 journals (75%) did not mention any form of trial or systematic review registration, and ClinicalTrials.gov was only recommended by only 1 journal (5%). Among top addiction medicine journals, required adherence to reporting guidelines and clinical trial registry policies remains substandard. A step toward fulfilling the National Institute on Drug Abuses' call for improvement in transparency and reproducibility within addiction research should include all journals adopting a strict reporting guideline and clinical trial registry adherence policy.

Use of venous couplers in microsurgical lower extremity reconstruction: A systematic review and meta-analysis.

Free tissue transfer for lower limb reconstruction has become a workhorse procedure for limb-salvage. Compared with other recipient sites, the lower extremity has a higher risk of microvascular complications, in particular with venous anastomosis. The study's objective is to evaluate the evidence, safety, and efficacy of venous coupler use in microsurgical anastomosis in lower limb reconstruction to provide objective appraisal of the surgical techniques. A systematic review (SR) and meta-analysis (MA) were performed analyzing articles from PubMed, Cochrane, Embase, and Web of Science from January 1990, to August 2018. Abstracts and titles were screened and assessed for eligibility by independent reviewers. Following full-text review, articles were included in the SR and MA. Case reports were excluded. Cochrane Collaboration and the Quality of Reporting of Meta-analyses (QUOROM) guidelines were followed. Out of 15 included studies that met the inclusion criteria for the SR, 9 were included in MA. Patients treated with venous couplers did not experience more surgical complications (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.48-1.33; p = .38), total failure (RR 0.61; 95% CI 0.22-1.70; p = .34), venous compromise (RR 0.72; 95% CI 0.23-2.27; p = .57), arterial compromise (RR 0.85; 95% CI 0.25-2.88; p = .80), partial failure (RR 0.77; 95% CI 0.33-1.77; p = .54), or reoperation (RR 11.79; 95% CI 0.49-286.55; p = .13) in comparison with hand-sewn anastomosis. Outcomes of venous couplers in lower limb reconstruction are comparable to those of hand-sewn anastomosis. However, this study was limited by the quality of the available literature. Additional prospective studies should aim to directly compare both techniques and potential further benefits in clinical trials.

Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses

ObjectiveThe purpose of this study was (1) to perform a summary of meta-analyses comparing platelet-rich plasma (PRP) injection with hyaluronic acid (HA) and placebo injection for KOA patients, (2) to determine which meta-analysis provides the best available evidence to making proposals for the use of PRP in the treatment of KOA patients, and (3) to highlight gaps in the literature that require future investigation.Material and methodsPubMed, EMBASE, and Cochrane databases search were performed for meta-analyses which compared PRP injection with HA or placebo. Clinical outcomes and adverse events were extracted from these meta-analyses. Meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses (QUOROM) systems and the Oxman-Guyatt quality appraisal tool. The Jadad decision algorithm was also used to determine which meta-analysis provided the best available evidence.ResultsFour meta-analyses were included in our study, and all of these articles were Level I evidence. The QUOROM score of each included meta-analysis range from 14 to 17 points (mean score 15, maximum score 18), and the Oxman-Guyatt score range from 4 to 6 points (mean score 5, maximum score 7). Three meta-analyses indicated PRP showed more benefit in pain relief and functional improvement than the control group, and the other one suggested no difference between these groups. All included meta-analyses found no statistical difference in adverse events between these groups. In addition, a meta-analysis conducted by Shen et al. got the highest methodological quality score and suggested that PRP provided better pain relief and function improvement in the treatment of KOA.ConclusionsFor short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo.Level of evidenceLevel I evidence, a summary of meta-analysesTrial registrationPROSPERO ID CRD42018116168

Treatment of Lateral Epicondylitis With Autologous Blood, Platelet-Rich Plasma, or Corticosteroid Injections: A Systematic Review of Overlapping Meta-analyses.

Background:Previous meta-analyses have been conducted to compare outcomes of various treatment injections for lateral epicondylitis (LE), including corticosteroid injection (CSI) and autologous blood products such as autologous blood (AB) and platelet-rich plasma (PRP).Purpose:To conduct a systematic review of overlapping meta-analyses comparing different injection treatments (CSI, AB, PRP) for LE to determine which meta-analyses provide the best available evidence.Study Design:Systematic review; Level of evidence, 2.Methods:A systematic review was performed by searching PubMed, Embase, and the Cochrane Library to locate meta-analyses that compared clinical outcomes of CSI, AB, and PRP for the treatment of LE. Search terms included “injection,” “corticosteroid,” “platelet-rich plasma,” “autologous blood,” “tennis elbow,” “lateral epicondylitis,” and “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes were extracted from these meta-analyses. Meta-analysis quality was assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence.Results:Nine meta-analyses (two level 1 studies, seven level 2 studies) containing 8656 patients met the eligibility criteria. Seven meta-analyses found that autologous blood products such as AB and PRP significantly improved pain and elbow function in the intermediate term (12-26 weeks), while 4 studies found that CSI effectively relieved pain and improved elbow function in the short term (<12 weeks). The study by Arirachakaran et al in 2016 received the highest QUOROM and Oxman-Guyatt scores; therefore, this meta-analysis appears to have the highest level of evidence. In addition, this study was rated the highest-quality study in this systematic review according to the Jadad decision algorithm. Lower-quality meta-analyses indicated that dosage, number of injections, and differences in therapeutic duration between CSI and autologous blood products may be essential factors in determining the appropriate treatment injection protocol for LE.Conclusion:The current best available evidence suggests that CSI improves functional outcomes and pain relief in the short term, while AB and PRP are the most effective treatments in the intermediate term.

Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update.

PurposeReporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines.Materials and methodsEight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).ResultsAmong the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines.ConclusionWe conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.

Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autografts for Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review of Overlapping Meta-analyses.

Background:Previous meta-analyses have compared bone–patellar tendon–bone (BPTB) with hamstring tendon (HT) autografts for primary anterior cruciate ligament reconstruction (ACLR).Purpose:To conduct a systematic review of overlapping meta-analyses comparing BPTB with HT autografts for ACLR to determine which meta-analyses provide the best available evidence.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was performed by searching the PubMed and Cochrane Library databases. Search words included “anterior cruciate ligament” AND “patellar tendon” AND “hamstring tendon” AND “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes and postoperative complications were extracted from the included meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) scores. The Jadad decision algorithm was then utilized to determine which meta-analyses provided the best level of evidence.Results:Sixteen meta-analyses containing an average of 1396 patients met the eligibility criteria. Most studies found BPTB autografts to provide superior stability but more postoperative complications, such as anterior knee pain and kneeling pain. Studies by Gabler et al (2016), Mohtadi et al (2011), and Xie et al (2015) received the highest Oxman-Guyatt and QUOROM scores, and therefore, these meta-analyses proved to provide the highest level of evidence. Additionally, Xie et al was selected as the highest-quality study in this systematic review based on the Jadad decision algorithm.Conclusion:The current best evidence suggests that ACLR with BPTB autografts provides superior static knee stability and that there are fewer postoperative complications in ACLR with HT autografts.

Systematic review adherence to methodological or reporting quality

BackgroundGuidelines for assessing methodological and reporting quality of systematic reviews (SRs) were developed to contribute to implementing evidence-based health care and the reduction of research waste. As SRs assessing a cohort of SRs is becoming more prevalent in the literature and with the increased uptake of SR evidence for decision-making, methodological quality and standard of reporting of SRs is of interest. The objective of this study is to evaluate SR adherence to the Quality of Reporting of Meta-analyses (QUOROM) and PRISMA reporting guidelines and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Overview Quality Assessment Questionnaire (OQAQ) quality assessment tools as evaluated in methodological overviews.MethodsThe Cochrane Library, MEDLINE®, and EMBASE® databases were searched from January 1990 to October 2014. Title and abstract screening and full-text screening were conducted independently by two reviewers. Reports assessing the quality or reporting of a cohort of SRs of interventions using PRISMA, QUOROM, OQAQ, or AMSTAR were included. All results are reported as frequencies and percentages of reports and SRs respectively.ResultsOf the 20,765 independent records retrieved from electronic searching, 1189 reports were reviewed for eligibility at full text, of which 56 reports (5371 SRs in total) evaluating the PRISMA, QUOROM, AMSTAR, and/or OQAQ tools were included. Notable items include the following: of the SRs using PRISMA, over 85% (1532/1741) provided a rationale for the review and less than 6% (102/1741) provided protocol information. For reports using QUOROM, only 9% (40/449) of SRs provided a trial flow diagram. However, 90% (402/449) described the explicit clinical problem and review rationale in the introduction section. Of reports using AMSTAR, 30% (534/1794) used duplicate study selection and data extraction. Conversely, 80% (1439/1794) of SRs provided study characteristics of included studies. In terms of OQAQ, 37% (499/1367) of the SRs assessed risk of bias (validity) in the included studies, while 80% (1112/1387) reported the criteria for study selection.ConclusionsAlthough reporting guidelines and quality assessment tools exist, reporting and methodological quality of SRs are inconsistent. Mechanisms to improve adherence to established reporting guidelines and methodological assessment tools are needed to improve the quality of SRs.

Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses

Background: Previous meta-analyses have been conducted to compare outcomes of early versus delayed motion after rotator cuff repair. Purpose: To conduct a systematic review of overlapping meta-analyses comparing early versus delayed motion rehabilitation protocols after rotator cuff repair to determine which meta-analyses provide the best available evidence. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed and Cochrane Library databases. Search terms included “rotator cuff repair,” “early passive motion,” “immobilization,” “rehabilitation protocol,” and “meta-analysis.” Results were reviewed to determine study eligibility. Patient outcomes and structural healing were extracted from these meta-analyses. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad decision algorithm was then used to determine which meta-analyses provided the best level of evidence. Results: Seven meta-analyses containing a total of 5896 patients met the eligibility criteria (1 Level I evidence, 4 Level II evidence, 2 Level III evidence). None of these meta-analyses found immobilization to be superior to early motion; however, most studies suggested that early motion would increase range of motion (ROM), thereby reducing time of recovery. Three of these studies suggested that tear size contributed to the choice of rehabilitation to ensure proper healing of the shoulder. A study by Chan et al in 2014 received the highest QUOROM and Oxman-Guyatt scores, and therefore this meta-analysis appeared to have the highest level of evidence. Additionally, a study by Riboh and Garrigues in 2014 was selected as the highest quality study in this systematic review according to the Jadad decision algorithm. Conclusion: The current, best available evidence suggests that early motion improves ROM after rotator cuff repair but increases the risk of rotator cuff retear. Lower quality meta-analyses indicate that tear size may provide a better strategy in determining the correct rehabilitation protocol.

153: A META-ANALYSIS ASSESSING THE QUALITY OF PUBLISHED ARTICLES BASED ON THE CHECKLIST QUOROM

Background and aims:The Quality of Reporting of Meta-analyses (QUOROM) conference was convened to address standards for improving the QUOROM of clinical randomized controlled trials (RCTs). The Structure of articles based...

Does Percutaneous Vertebroplasty or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures Increase the Incidence of New Vertebral Fractures? A Meta-Analysis

Background: Because of an aging population,osteoporotic vertebral fractures are becoming more frequent. Conservative therapy was considered the gold standard for treating osteoporotic vertebral compression fractures (OVCFs) in the past. Percutaneous vertebroplasty (PVP) or balloon kyphoplasty (BKP) as minimally invasive techniques are new treatments that arewidely used for painful OVCFs. However, an increase in new vertebral compression fractures at non-treated levels following augmentation is of concern. There is no convincing evidence that new fractures are inevitable after augmentation compared to after conservative treatment, and it is still unclear whether further fractures are the consequence of augmentation ora result of the natural progression of osteoporosis. Objective: The objective of this study was to evaluate the new-level fracture risk after PVP or BKP compared with conservative (non-operative) treatment and to determine the dominant risk factor associated with new OVCFs. Study Design: A meta-analysis of comparative studies was performed to evaluate the incidence of new vertebral fractures between vertebral augmentation, such as vertebroplasty and kyphoplasty, and no operation. Setting: The PubMed,ISI Web of Science, ELSEVIER ScienceDirect, and Cochrane Library databases and abstracts published in annual proceedings were systematically searched.In addition, we also retrieved data from references when titles met our inclusion criteria. Methods: Detailed searches of a number of online databases comparing operative and non-operative groups were performed. We included randomized controlled trials,clinical controlled trials,and prospective clinical studies to provide available data. All studies were reviewed by 2 reviewers independently, and all the references that met our inclusion criteria were searched for additional trials, using the guidelines set by the QUOROM (Quality of Reporting of Meta-analysis) statement. Results: We evaluated 12 studies encompassing 1,328 patients in total,including 768 who underwent operation with polymethylmethacrylateand 560 who received non-operative treatments. For new-level vertebral fractures, our meta-analysis found no significant difference between the 2 methods, including total new fractures (P = 0.55) and adjacent fractures (P = 0.5).For pre-existing vertebral fractures, there was no significant difference between the 2 groups (operative and non-operative groups) (P = 0.24). Additionally,there was no significant difference in bone mineral density, both in the lumbar (P = 0 .13) and femoral neck regions (P = 0.37), between the 2 interventions. Limitation: All studies we screened were published online except for unpublished articles. Moreover, only a few data sources could be extracted from the published studies. There were only 5 randomized clinical trials and 7 prospective studies that met our inclusion criteria. Conclusion: Vertebral augmentation techniques, such as vertebroplasty and kyphoplasty, have been widely used to treat osteoporotic vertebral fractures in order to alleviate back pain and correct the deformity, and it has been frequently reported that many new vertebral fractures occurred after this operation. Our analysis did not reveal evidence of an increased risk of fracture of vertebral bodies, especially those adjacent to the treated vertebrae, following augmentation with either method compared with conservative treatment. Key words: Vertebroplasty, kyphoplasty, new osteoporotic compression vertebral fracture, meta-analysis

Reevaluation of Meta-analysis on prophylactic drug management for recurrence of febrile seizures

Objective To explore the efficiency and safety of drugs to prevent the recurrence of febrile seizures (FS). Methods Relevant literatures were searched via PubMed, EMBASE/SCOPUS, EBSCO-CINAHL, Web of Science, Cochrane Database of Systematic Reviews from December 1997 to November 2014 using the following keywords: febrile seizure OR febrile convulsion, recurrence, prevention OR prophylaxis, medicine OR medication. Publication type was limited to Meta-analysis. Extract the relevant information of Meta-analysis, such as characteristics of objects, types of study design, number of clinical trials, number of cases, search strategies, databases, information of methodology (methods of randomization, concealment, blinding, withdrawal and exit), follow-up time, heterogeneity analysis, subgroup analysis and outcome assessment, etc. Quality of Reporting of Meta-analyses (QUOROM) and Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ) were used to assess the quality of included Meta-analyses. Jadad decision was used to assess inclusion and exclusion criteria, search strategies, effectiveness evaluation, data extraction and data analysis, to explore reliable evidence of evidence-based medicine. Results Eventually, four Meta-analyses were included after screening of all the literatures that can be searched out. Among those Meta-analyses, the Meta-analysis of Offringa and Newton (2012) was relatively more reliable. The results suggesed that no clinically important benefits were found in administering intermittent oral or rectal diazepam, oral phenobarbitone, phenytoin, valproate, pyridoxine, buprofen, diclofenac and acetominophen to children with FE. Only one clinical trial reported that intermittent oral clobazam could reduce the recurrence of FE in comparing with placebo at 6-month follow-up ( RR = 0.360, 95% CI: 0.200-0.640; P = 0.000), but it should be verified by more randomized controlled trials (RCTs). Among 4 Meta-analyses included in this study, the Meta-analyses of Rosenbloom (2013), Masuko (2003) and Rantala (1997) did not mention the problems of publication bias; in the Meta-analysis of Offringa and Newton (2012), a funnel plot was applied for evaluation of this problem, however, no quantitative analysis was conducted to evaluate the effect of publication bias on the validity of conclusions and no further processing was mentioned. Conclusions In view of good prognosis of recurrent FE, unsure efficacy of preventive medicine and high risk of adverse drug reactions, it should not be routinely recommended the use of antiepileptic drugs, antipyretic drugs or pyridoxine to prevent the recurrence of FE. DOI: 10.3969/j.issn.1672-6731.2015.08.011

Operative vs. Non-Operative Treatment of Achilles Tendon Ruptures

Objectives:Background: Multiple meta-analyses have been published to in efforts to determine whether operative or non-operative treatment of Achilles tendon ruptures affords superior outcomes. The results, however, remain varied and inconsistent.Purpose:To perform a systematic review of overlapping meta-analyses comparing operative and non-operative treatment of Achilles tendon ruptures in order to determine which meta-analyses provide the highest level of evidence for treatment recommendations.Methods:Methods: A systematic review of the literature was performed to identify meta-analyses that fit our inclusion criteria. Data was extracted from these meta-analyses regarding patient outcomes and re-ruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence.Results:Results: Nine meta-analyses met the eligibility criteria, with all but one study including level I evidence. A total of 5,842 patients were included. Seven studies found a higher rate of rerupture in the non-operative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and one study found surgery decreased rerupture rates only when compared to non-operative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 out of 9) of the meta-analyses had Oxman-Guyatt scores (>3) indicating no major flaws.Conclusion:Conclusions: Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared to non-operative treatment. Additionally, surgical treatment may allow earlier return to work.

Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?: A Systematic Review of Overlapping Meta-analyses.

Background:Multiple meta-analyses have been published in efforts to determine whether operative or nonoperative treatment of Achilles tendon ruptures affords superior outcomes.Purpose:To perform a systematic review of overlapping meta-analyses comparing operative and nonoperative treatment of Achilles tendon ruptures to determine which meta-analyses provide the highest level of evidence for treatment recommendations.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic review of the literature was performed to identify meta-analyses that fit the study inclusion criteria. Data were extracted from these meta-analyses regarding patient outcomes and reruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence.Results:Nine meta-analyses met the eligibility criteria, with all but 1 study including level 1 evidence. A total of 5842 patients were included. Seven studies found a higher rate of rerupture in the nonoperative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and 1 study found surgery decreased rerupture rates only when compared with nonoperative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 of 9) of the meta-analyses had Oxman-Guyatt scores >3, indicating no major flaws.Conclusion:Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared with nonoperative treatment. Additionally, surgical treatment may allow earlier return to work.

When may systematic reviews and meta-analyses be considered reliable?

When may systematic reviews and meta-analyses be considered reliable?

Abstract B05: GSTM1 as risk factor for breast cancer: Meta-analysis of 57 studies

Abstract Purpose: To examine the association of glutathione S-transferase Mu 1 (GSTM1) and other risk factors for breast cancer. Breast cancer is the most common malignancy and the second leading cause of cancer death among women in the United States. As identified from the most recent genome-wide association studies (GWAS) and meta-analyses, GSTM1 is listed as one of the most published breast cancer genes for various race-ethnicities. GSTM1 present/null genotypes are low-penetrance cancer susceptibility genes; and these types of genes acting together with endogenous and lifestyle risk factors, account for majority of breast cancers. GSTM1 plays a key role in detoxification of environmental carcinogens such as smoking and alcohol, steroid hormone metabolism, and deoxyribonucleic acid (DNA) damage repair pathways. Procedure: PubMed databases were search with key words “breast cancer” and “GSTM1” up to the most recent publications. Full texts of 158 articles were reviewed. Articles were selected based on the following criteria: a) evaluation of the GSTM1 present/null gene variation and breast cancer risk, b) case-control studies, c) sufficient published data for estimating relative risk (RR) with 95% confidence interval (CI). All selected publicationswere evaluated and scored for quality using the rating indicators from Quality of Reporting of Meta-analyses (QUOROM) framework. Based on the sets of criteria, studies with poor quality rating score and repeated use of data from the same authors are excluded from meta-analyses. The sets of criteria for quality provided an objective measure for inclusion of studies in meta-analysis, which enhanced rigor of research. An inter-rater reviewed the selection of publications and quality data rating scores. Total of 57 studies with 17,102 cases and 17,932 controls were included in meta-analysis. These studies included samples from different race-ethnicities worldwide. Findings: In the overall pooled analysis, GSTM1 present genotype significantly decreased breast cancer risk (RR = 0.96, 95% CI = 0.93 to 0.99, p = 0.01) suggesting its protective effect. The same findings of decreased breast cancer risk with present genotype were noted for Caucasians (RR = 0.96, 95% CI = 0.92 to 0.99, p = 0.02). On the other hand, significantly elevated breast cancer risk was associated with GSTM1 null genotype when all studies were pooled into meta-analysis (RR = 1.05, 95% CI = 1.01 to 1.08, p = 0.009). In the subgroup analysis by ethnicity, significantly increased risks were found in Asians (RR = 1.11, 95% CI = 1.02 to 1.21, p = 0.02). These findings support that individuals with GSTM1 null genotype are more susceptible to DNA damage and carcinogenesis. Lifestyle behaviors such as smoking, alcohol intake, and diet low in isothiocyanates (ITCs) (i.e. cruciferous vegetables and fibers) were significantly associated with GSTM1 genotypes and breast cancer risk. The protective effects of dietary ITCs were seen more on individuals with GSTM1 null genotype than those with GSTM1 positive. Conclusion: This meta-analysis suggests that the GSTM1 null genotype is a low-penetrant risk factor for developing breast cancer and the present genotype is protective for breast cancer development. Future in-depth researches are necessary to understand gene-environment interactions including lifestyle behaviors that may elucidate inconsistent findings of previous studies. The outcome of the study can provide useful insights of GSTM1 as risk factor for breast cancer, which can further generate useful evidence for larger studies in different populations. Identification of protective GSTM1 genotype and lifestyle behaviors are useful in laying out the foundation for cancer prevention through innovative behavioral interventions. Citation Format: Mildred C. Gonzales, Pamela Shiao, Amanda Lie, Ching-Yi Chiu, Maria Suarez. GSTM1 as risk factor for breast cancer: Meta-analysis of 57 studies. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B05.

Abstract B07: A meta-analysis of GSTM1 human genome as risk factor in lung cancer prevention

Abstract Purpose: Lung cancer is the highest cause of cancer related death in the United States. Its development is attributed to environmental and genetic factors. Smoking, diet, and occupation are environmental factors that can affect its development. Besides the environmental elements, the genetic aspect of this risk has also been identified as a major factor. Polymorphism in an individual's genotype has been recognized as a possible risk for lung cancer. GSTM1 has been one of the genes being studied with regards to genetic polymorphism affecting lung cancer development. A meta-analysis was conducted to examine the association of GSTM1 human genome as a risk factor for lung cancer. Procedure: Literature searches were completed by searching at three different times using keyword related to human GSTM1 and lung cancer. The searches generated 326 papers. The preliminary count includes 138 case-control studies. Quality rating of the literatures included will be based on Quality of Reporting of Meta-analysis (QUOROM). GSTM1 genes are categorized into present and null deletion genotype. Each category will be grouped by country and ethnicity. Inter-rater evaluation will be done for quality rating and gene count to ensure accurate appraisal of data collected. Pooled relative risks will be computed for each genotype and ethnicity to determine association with lung cancer. Findings: With the total cases of 12,288 and control subjects of 16,836, this meta-analysis is able to ascertain the association of GSTM1 with lung cancer risk. The present genotype of GSTM1 has been established as protective in nature (P &amp;lt; 0.05). In addition, the relative risk for the null genotype showed significance (P &amp;lt; 0.05) affirming its association to increased risk of developing lung cancer. In examining the subgroups for the study, only the Asian group shows a significant relative risk for both present and null genotype. Additionally, among the three Asian countries in the group, only China showed a significant relative risk for lung cancer development in the null genotype and it did not show significant relative risk for the protective genotype. On the contrary, Japan showed significance in association with the protective genotype. Further reviews confirmed that dietary factor such as intake of cruciferous vegetables, fruits, and green teas affect the development of lung cancer. Conclusion: The association between GSTM1 and lung cancer has been established through this meta-analysis. The results from this meta-analysis prompt the need for further studies that examine GSTM1 genotypes with inclusion of more studies for various race-ethnicity groups and countries. GSTM1 present genotype has an essential role in preventing lung cancer. There is a need to identify ways to enhance or maintain this GSTM1 genotype in future studies. Dietary intake of cruciferous vegetables is a promising factor in preventing lung cancer. Citation Format: Maria Suarez, S. Pamela Shiao, Mildred Gonzales, Amanda Lie, Ching-Yi Chiu. A meta-analysis of GSTM1 human genome as risk factor in lung cancer prevention. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B07.

A systematic scoping review of adherence to reporting guidelines in health care literature

BackgroundReporting guidelines have been available for the past 17 years since the inception of the Consolidated Standards of Reporting Trials statement in 1996. These guidelines were developed to improve the quality of reporting of studies in medical literature. Despite the widespread availability of these guidelines, the quality of reporting of medical literature remained suboptimal. In this study, we assess the current adherence practice to reporting guidelines; determine key factors associated with better adherence to these guidelines; and provide recommendations to enhance adherence to reporting guidelines for future studies.MethodsWe undertook a systematic scoping review of systematic reviews of adherence to reporting guidelines across different clinical areas and study designs. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, Web of Science, Embase, and Medline) from January 1996 to September 2012. Studies were included if they addressed adherence to one of the following guidelines: Consolidated Standards of Reporting Trials (CONSORT), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), Quality of Reporting of Meta-analysis (QUOROM), Transparent Reporting of Evaluations with Nonrandomized Designs (TREND), Meta-analysis Of Observational Studies in Epidemiology (MOOSE) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). A protocol for this study was devised. A literature search, data extraction, and quality assessment were performed independently by two authors in duplicate. This study reporting follows the PRISMA guidelines.ResultsOur search retrieved 5159 titles, of which 50 were eligible. Overall, 86.0% of studies reported suboptimal levels of adherence to reporting guidelines. Factors associated with better adherence included journal impact factor and endorsement of guidelines, publication date, funding source, multisite studies, pharmacological interventions and larger studies.ConclusionReporting guidelines in the clinical literature are important to improve the standards of reporting of clinical studies; however, adherence to these guidelines remains suboptimal. Action is therefore needed to enhance the adherence to these standards. Strategies to enhance adherence include journal editorial policies endorsing these guidelines.

The Surgical Treatment for Portal Hypertension: A Systematic Review and Meta-Analysis

Aim. To compare the effectiveness of surgical procedures (selective or nonselective shunt, devascularization, and combined shunt and devascularization) in preventing recurrent variceal bleeding and other complications in patients with portal hypertension. Methods. A systematic literature search of the Medline and Cochrane Library databases was carried out, and a meta-analysis was conducted according to the guidelines of the Quality of Reporting Meta-Analyses (QUOROM) statement. Results. There were a significantly higher reduction in rebleeding, yet a significantly more common encephalopathy (P = 0.05) in patients who underwent the shunt procedure compared with patients who had only a devascularization procedure. Further, there were no significant differences in rebleeding, late mortality, and encephalopathy between selective versus non-selective shunt. Next, the decrease of portal vein pressure, portal vein diameter, and free portal pressure in patients who underwent combined treatment with shunt and devascularization was more pronounced compared with patients who were treated with devascularization alone (P < 0.05). Conclusions. This meta-analysis shows clinical advantages of combined shunt and devascularization over devascularization in the prevention of recurrent variceal bleeding and other complications in patients with portal hypertension.

Analysis of the Methodologic Quality of Reporting of Meta-Analyses in Anesthesiology and Pain Medicine

Study Objective: In 1999, the Quality of Reporting Meta-analyses (QUOROM) conference was convened to set standards for meta-analysis reporting. Although the number of meta-analyses has increased over the past decade, the overall scientific quality of meta-analysis reporting in the anesthesiology and pain-medicine literature is unclear. We undertook a literature review of published meta-analyses in the fields of anesthesiology and pain medicine to describe the quality of reporting. Methods: Meta-analyses relevant to the fields of anesthesiology and pain medicine were identified by a literature search of the Medline, EMBASE, CINAHL, and Cochrane databases. Search terms included combinations of anesth* or anaesth*, preoperative, postoperative, analgesia, pain, and meta-analysis or meta-analyses. Critical care medicine articles were excluded. Publication-related data were extracted from each accepted meta-analysis. The quality of reporting for each meta-analysis was scored by using the Overview Quality Assessment Questionnaire (OQAQ) and the QUOROM checklist. Results: A total of 374 meta-analyses were included and reviewed. The mean (± SD) overall OQAQ score for all publications was 23.9 ± 2.5 out of a maximum possible score of 27. The mean QUOROM score for all publications was 14.3 ± 2.6 out of a maximum possible score of 18. The quality of reporting of meta-analyses correlated with the region of origin and type of journal (non-anesthesiology > anesthesiology) but not with anesthesia subspecialty. Scores obtained by both OQAQ and QUOROM were higher for meta-analyses published after the QUOROM guidelines were released than for those published earlier. Conclusions: The quality of reporting of meta-analyses in the fields of anesthesiology and pain medicine has improved since publication of the QUOROM guidelines.