Systematic Reviews And Meta-analyses Research Articles

High variability in results and methodological quality among overlapping systematic reviews on the same topics in surgery: a meta-epidemiological study.

Redundant publication of systematic reviews and meta-analyses (SRs/MAs) on the same topic presents an increasing burden for clinicians. The aim of this study was to describe variabilities in effect size and methodological quality of overlapping surgery-related SRs/MAs and to investigate factors associated with their postpublication citations. PubMed/MEDLINE was searched to identify SRs/MAs of RCTs on thoracoabdominal surgeries published in 2015. Previous SRs/MAs on the same topics published within the preceding 5 years (2011-2015) were identified and 5-year citation counts (through to 2020) were evaluated. Discrepancies in pooled effect sizes and their methodological quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) among overlapping SRs/MAs were assessed. The SR/MA-level factors associated with 5-year citation counts were explored, using a mixed-effects regression model with a random intercept for surgical topics. A total of 57 surgery-related SRs/MAs (48 topics) published in 2015 were identified, and 146 SRs/MAs had overlapping publications on 29 topics (60.4 per cent of all topics) in the preceding 5 years. There was considerable variability in methodological quality of SRs/MAs and coverage probability for relevant RCTs, resulting in discrepant effect size estimates for the same topic. High quality (AMSTAR score 8-11) was independently associated with higher 5-year citation counts (coefficient = 32.82; 95 per cent c.i. 15.63 to 50.02; P < 0.001). Overlapping SRs/MAs with high variability in results and methodological quality were common in surgery. A high-quality SR/MA score was an independent predictor of more frequent citations. Researchers and journal editors should concentrate their efforts on limiting publications to higher-quality reviews.

Harms in Systematic Reviews Paper 2: Methods used to assess harms are neglected in systematic reviews of gabapentin

ObjectiveWe compared methods used with current recommendations for synthesizing harms in systematic reviews and meta-analyses (SRMAs) of gabapentin. Study Design & SettingWe followed recommended systematic review practices. We selected reliable SRMAs of gabapentin (i.e., met a pre-defined list of methodological criteria) that assessed at least one harm. We extracted and compared methods in four areas: pre-specification, searching, analysis, and reporting. Whereas our focus in this paper is on the methods used, Part 2 examines the results for harms across reviews. ResultsWe screened 4320 records and identified 157 SRMAs of gabapentin, 70 of which were reliable. Most reliable reviews (51/70; 73%) reported following a general guideline for SRMA conduct or reporting, but none reported following recommendations specifically for synthesizing harms. Across all domains assessed, review methods were designed to address questions of benefit and rarely included the additional methods that are recommended for evaluating harms. ConclusionApproaches to assessing harms in SRMAs we examined are tokenistic and unlikely to produce valid summaries of harms to guide decisions. A paradigm shift is needed. At a minimal, reviewers should describe any limitations to their assessment of harms and provide clearer descriptions of methods for synthesizing harms.

P.228 Pre-operative Surrogates Markers of Frailty and Metastatic Spine Disease: Systematic Review

Background: Despite the inherent importance of physical reserve and ability to tolerate surgery, pre-operative patient-specific surrogate markers of frailty that may improve accuracy of outcome prognostication following surgery for SMD are not well described. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, Scopus, EMBASE, Cochrane Registry of Controlled Trials, CINAHL, and Web of Science were searched. Quality of evidence was scored using the Oxford CEBM Scoring Tool. Results: Forty studies accounted for 8,364 patients. Surgical indications included neurological dysfunction, intractable pain, and spinal instability. Tumor histology varied across and within studies. Age, gender, performance status, neurologic function, comorbidities, and biochemical abnormalities were the most frequently analyzed pre-operative surrogate markers of frailty. The most commonly assessed outcomes were overall and progression-free survival; few studies examined health-related quality of life, peri-operative adverse events, and post-operative complications. Conclusions: This study highlights the need for objective measures of frailty in order to improve risk stratification and outcome prognostication among patients receiving surgery for metastatic spinal disease. Future studies should address identified knowledge gaps pertaining to peri-operative adverse events, post-operative complications, and health-related quality of life outcomes.

The state of birth asphyxia in Ethiopia: An umbrella review of systematic review and meta-analysis reports, 2020

BackgroundTo this date, there are 4 systematic reviews and meta-analyses studies about the burden and associated factors of birth asphyxia in Ethiopia. However, findings of these studies are inconsistent which is difficult to make use of the findings for preventing birth asphyxia in the country. Therefore, umbrella review of these studies is required to pool the inconsistent findings into a single summary estimate that can be easily referred by the information users in Ethiopia. MethodsPubMed, Science direct, web of science, data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects were searched for systematic reviews and meta-analyses (SRM) studies on the magnitude and risk factors of perinatal asphyxia in Ethiopia. The methodological quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. The estimates of the included SRM studies on the prevalence and predictors of perinatal asphyxia were pooled and summarized with random-effects meta-analysis models. From checking PROSPERO, this umbrella review wasn't registered. ResultsWe included four SRM studies with a total of 49,417 neonates. The summary estimate for prevalence of birth asphyxia was 22.52% (95% CI = 17.01%–28.02%; I2 = 0.00). From the umbrella review, the reported factors of statistical significance include: maternal illiteracy [AOR = 1.96; 95% CI: 1.44–2.67], primiparity [AOR = 1.29; 95% CI: 1.03–1.62], antepartum hemorrhage [AOR = 3.43; 95% CI: 1.74–6.77], pregnancy induced hypertension [AOR = 4.35; 95% CI: 2.98–6.36], premature rupture of membrane [AOR = 12.27; 95% CI: 2.41, 62.38], prolonged labor [AOR = 3.18; 95% CI: 2.75, 3.60], meconium-stained amniotic fluid [AOR = 5.94; 95% CI: 4.86, 7.03], instrumental delivery [AOR = 3.39; 95% CI: 2.46, 4.32], non-cephalic presentation [AOR = 3.39; 95% CI: 1.53, 5.26], cord prolapse [AOR = 2.95; 95% CI: 1.64, 5.30], labor induction [AOR = 3.69; 95% CI: 2.26–6.01], cesarean section delivery [AOR = 3.62; 95% CI: 3.36, 3.88], low birth weight [AOR = 6.06; 95% CI: 5.13, 6.98] and prematurity [AOR = 3.94; 95% CI: 3.67, 4.21] at 95% CI. ConclusionThis umbrella review revealed high burden of birth asphyxia in Ethiopia. The study also indicated significant risk of birth asphyxia among mothers who were unable to read and write, primiparous mothers, those mothers having antepartum hemorrhage, pregnancy induced hypertension, premature rupture of membrane, prolonged labor, meconium-stained amniotic fluid, instrumental delivery, cesarean section delivery, non-cephalic presentation, cord prolapse and labor induction. Moreover, low birth weight and premature neonates were more vulnerable to birth asphyxia compared to their normal birth weight and term counterparts. Therefore, burden of birth asphyxia should be mitigated through special consideration of these risk mothers and neonates during antenatal care, labor and delivery. Mitigation of the problem demands the collaborative efforts of national, regional and local stakeholders of maternal and neonatal health.

Clinical Epidemiology in China series. Paper 3: The methodological and reporting quality of systematic reviews and meta-analyses published by China' researchers in English-language is higher than those published in Chinese-language

ObjectiveTo assess the methodological and reporting quality of Chinese- and English -language systematic reviews and meta-analyses (SRs/MAs) published by Chinese authors between 2016 and 2018. Study Design and SettingWe searched MEDLINE and Chinese Science Citation Database (CSCD) for SRs/MAs led by Chinese authors published between 2016 and 2018. We used random sampling to select 10% of the eligible SRs/MAs published in each year from CSCD, and then matched the same number of SRs/MAs in MEDLINE. Reporting quality was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and methodological quality using the Assessment of Multiple Systematic Reviews (AMSTAR-2) tool. Stratified analyses were conducted to compare the differences of quality between Chinese- and English language SRs/MAs. ResultsWe identified 336 SRs/MAs (168 in Chinese and 168 in English). The reporting quality in Chinese-language SRs/MAs was slightly lower than English-language SRs/MAs (mean PRISMA scores: 20.58 vs. 21.71 in 2016, 19.87 vs. 21.24 in 2017, and 21.29 vs. 22.38 in 2018). Less than half of both Chinese- and English-language SRs/MAs complied with item 5 (protocol and registration), item 7 (information sources), item 8 (search) and item 27 (funding)). The methodological quality in Chinese -language SRs/MAs was also slightly lower than English -language SRs/MAs (mean AMSTAR-2 scores: 8.07 vs. 9.36 in 2016; 9.21 vs. 10.26 in 2017; 8.86 vs. 9.28 in 2018). Three items (item 2: established a protocol; item 4: use a comprehensive literature search; and item 10: report the sources of funding) were adhered to by less than 10% of both Chinese- and English -language SRs/MAs. Only one (0.6%) Chinese-language SRs/MA and nine (5.4%) English-language SRs/MAs were rated as high methodological quality. ConclusionThe reporting and methodological quality of English-language SRs/MAs conducted by authors from China between 2016 and 2018 were slightly better than those of Chinese -language SRs/MAs.

An umbrella review of effect size, bias, and power across meta-analyses in emergency medicine.

The objective of this study was to conduct an umbrella review of therapeutic studies relevant to emergency medicine, analyzing patterns in effect size, power, and signals of potential bias across an entire field of clinical research. We combined topic- and journal-driven searches of PubMed and Google Scholar for published articles of systematic reviews and meta-analyses (SRMA) relevant to emergency medicine (last search in November 2020). Data were screened and extracted by six investigators. Redundant meta-analyses were removed. Whenever possible for each comparison we extracted one meta-analysis on mortality with the most events and one meta-analysis on a nonmortality outcome with the most studies. From each meta-analysis we extracted all individual study effects; outcomes were converted to odds ratios (ORs) and placed on a common scale where an OR < 1.0 represents a reduction in a harmful outcome with an experimental treatment versus control. Outcomes were analyzed at the level of individual studies and at the level of summary effects across meta-analyses. A total of 332 articles contained 431 eligible meta-analyses with a total of 3,129 individual study outcomes; of these, 2,593 (83%) were from randomized controlled trials. The median OR across all studies was 0.70. Within each meta-analysis, the earliest study effect on average demonstrated larger benefit compared to the overall summary effect. Only 57 of 431meta-analyses (13%) both favored the experimental intervention and did not show any signal of small study effects or excess significance, and of those only 12had at least one study with 80% or higher power to detect an OR of 0.70. Of these, no interventions significantly decreased mortality in well-powered trials. Although the power of studies increased somewhat over time, the majority of studies were underpowered. Few interventions studied within SRMAs relevant to emergency medicine seem to have strong and unbiased evidence for improving outcomes. The field would benefit from more optimally powered trials.

The Influence of Diabetes Mellitus on Rotator Cuff Repair: A Systematic Review and Meta-Analysis.

Clinical outcomes after rotator cuff repair associated with diabetes mellitus (DM) are generally favorable, but no study has attempted to establish the influence of DM on outcomes after rotator cuff repair. To conduct a meta-analysis of clinical studies evaluating patient outcomes between people with DM and people without DM after rotator cuff repair. Meta-analysis. A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies about clinical outcomes after rotator cuff repair comparing people with DM and people without DM were included. Statistical analysis was performed with RevMan (v 5.3.3). Nine clinical studies that met the inclusion criteria were identified and included a total of 314 patients treated with DM and 1092 patients without DM. The failure rate was significantly higher in the DM group than in Non-DM group (23.97% compared with 16.60%, OR: 2.39; 95% CI, 1.69-3.37; p < 0.001). The postoperative retear rate and showed a significant difference between the two groups (24.5% and 13.7%; OR: 2.41; 95% CI, 1.57-3.71; p<0.001). The DM group showed a higher rate of postoperative unhealed cuff than the Non-DM group(41.81% and 25.23%; OR: 2.14; 95% CI, 1.69-3.37; p=0.01).Postoperative Range of motion(ROM) at 12 months after surgery show a significant difference in the range of external rotation between two groups (WMD: -6.02; 95% CI, -7.54 to -4.50; p<0.001). The preoperative Japanese Orthopaedic Association (JOA) score, the comparison of pre- and post-operative JOA scores showed a significant difference in the DM and Non-DM group(p<0.001). The postoperative JOA score, the pre- and post-operative muscle strength, the pre- and post-operative visual analog scale (VAS) show significant difference between the DM and Non-DM group(p<0.001). The postoperative infection rates, the rates of postoperative shoulder stiffness, the preoperative ROM, the postoperative ROM at 6 months, the postoperative ROM at 12 months of forward flexion and abduction, the American Shoulder and Elbow Surgeons score, the University of California, Los Angeles scores, and the preoperative Constant-Murley scores show no significant difference between the two groups. This meta-analysis indicates that DM may be relative to a higher rate of shoulder retear and cuff unhealing. However, patients with DM can achieve great clinical outcomes after cuff repair, compared to patients without DM.

Effectiveness of vector control methods for the control of cutaneous and visceral leishmaniasis: A meta-review.

Elimination of visceral leishmaniasis (VL) in Southeast Asia and global control of cutaneous leishmaniasis (CL) and VL are priorities of the World Health Organization (WHO). But is the existing evidence good enough for public health recommendations? This meta-review summarises the available and new evidence for vector control with the aims of establishing what is known about the value of vector control for the control of CL and VL, establishing gaps in knowledge, and particularly focusing on key recommendations for further scientific work. This meta-review follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) criteria, including (1) systematic reviews and meta-analyses (SRs/MAs) for (2) vector control methods and strategies and (3) for the control of CL and/or VL. Nine SRs/MAs were included, with different research questions and inclusion/exclusion criteria. The methods analysed for vector control can be broadly classified into (1) indoor residual spraying (IRS); (2) insecticide-treated nets (ITNs; including insecticide-impregnated bednets); (3) insecticide-treated curtains (ITCs; including insecticide-treated house screening); (4) insecticide-treated bedsheets (ITSs) and insecticide-treated fabrics (ITFs; including insecticide-treated clothing) and (5) durable wall lining (treated with insecticides) and other environmental measures to protect the house; (6) control of the reservoir host; and (7) strengthening vector control operations through health education. The existing SRs/MAs include a large variation of different primary studies, even for the same specific research sub-question. Also, the SRs/MAs are outdated, using available information until earlier than 2018 only. Assessing the quality of the SRs/MAs, there is a considerable degree of variation. It is therefore very difficult to summarise the results of the available SRs/MAs, with contradictory results for both vector indices and—if available—human transmission data. Conclusions of this meta-review are that (1) existing SRs/MAs and their results make policy recommendations for evidence-based vector control difficult; (2) further work is needed to establish efficacy and community effectiveness of key vector control methods with specific SRs and MAs (3) including vector and human transmission parameters; and (4) attempting to conclude with recommendations in different transmission scenarios.

Effect of exercise training on weight loss, body composition changes, and weight maintenance in adults with overweight or obesity: An overview of 12 systematic reviews and 149 studies.

SummaryThis overview of reviews aimed to summarize the effects of exercise training programs on weight loss, changes in body composition, and weight maintenance in adults with overweight or obesity. A systematic search of systematic reviews and meta‐analyses (SR‐MAs) published between 2010 and December 2019 was performed. Only SR‐MAs of controlled trials were included. The mean difference (MD) or standardized MD (SMD) were extracted from SR‐MAs. Twelve SR‐MAs (149 studies) were included. Exercise led to a significant weight loss (4 SR‐MAs, MDs ranging from −1.5 to −3.5 kg), fat loss (4 SR‐MAs, MDs ranging from −1.3 to −2.6 kg) and visceral fat loss (3 SR‐MAs, SMDs ranging from −0.33 to −0.56). No difference in weight, fat, and visceral loss was found between aerobic and high‐intensity interval training as long as energy expenditure was equal. Resistance training reduced lean mass loss during weight loss (1 SR‐MA, MD: 0.8 [95%CI: 0.4–1.3] kg). No significant effect of exercise was found on weight maintenance (1 SR‐MA). These findings show favorable effects of exercise training on weight loss and body composition changes in adults with overweight or obesity. Visceral fat loss may lead to benefits for cardiometabolic health. More research is needed to identify training modalities that promote weight maintenance.

Agrochemicals Residues in Human Milk, Scientific Evidence or Overestimated Risk?

Background: Exposures to agrochemicals can be directly through the handling of chemicals as well as indirectly when consuming food containing residues of them. Such exposure may affect the health of the population if accumulated in the human body, including in human milk. Objective: This literature review aims to assess the potential impact of agrochemical residues in human milk as a barrier to breastfeeding. Methods: The search followed PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta Analyses), by selecting original articles published between 1995 and 2019, extracted from the free access databases PubMed, Scielo, Web of Sciences and Scopus using as keywords: agrochemicals, pesticides, breastfeeding, human milk, contamination and infant. Medical Subject Headings (MeSH) were used as descriptors. Results: We selected 11 studies. Taking as inclusion criteria those most aligned with the objective of our study. Conclusion: The studies presented in this review ratified the benefits of breastfeeding compensating for the potential risks of agrochemical residues in human milk.

The reporting and methodological quality of systematic reviews and meta-analyses of nursing interventions for chronic obstructive pulmonary disease - A systematic review.

AimsThe aim of this review was to evaluate the reporting and methodological quality of systematic reviews and meta‐analyses (SRs/MAs) on nursing interventions in patients with chronic obstructive pulmonary disease (COPD) and to determine potential factors that predict high quality.DesignThe review is a quantitative systematic review.Data SourcesPubMed, Embase and the Cochrane Database of Systematic Reviews.Review MethodsA comprehensive literature search was conducted in three databases for SRs/MAs published up to 6 May 2020. The PRISMA statement and AMSTAR checklist were used to evaluate the reporting and methodological quality.ResultsA total of 130 articles published between 1996–2020 from 69 journals were included in this review. Multivariate regression analyses demonstrated that the following factors were related to the higher reporting quality of included articles: having a protocol or registration and being published on the Cochrane Database of Systematic Reviews. Systematic reviews including meta‐analyses, number of authors >5, number of pages and having protocol or registration were related to higher methodological quality. A strong linear correlation (r = 0.860) was detected between the scores of PRISMA and AMSTAR.ConclusionA significant number of systematic reviews and meta‐analyses on nursing interventions in patients with COPD show suboptimal reporting and poor methodology quality. The use of PRISMA and AMSTAR guidelines in conducting, reading, reviewing and editing systematic reviews and meta‐analyses is recommended to improve the quality of systematic reviews and meta‐analyses.ImpactThe findings of this review can provide references for health workers and health policy makers to evaluate and apply evidence‐based knowledge. Additionally, such high‐quality systematic reviews/meta‐analyses can guide medical and health practice.

Perspective on Systematic Medical Literature Reviews and Meta-Analyses

This study sought to identify factors contributing to the inadequacies of systematic reviews and meta-analyses (SRMAs) published in the ophthalmology literature. Perspective. Review and synthesis of selective literature, with interpretation and perspective. Although recommendations for the design, conduct, assessment of quality, and risk of bias of systematic reviews have been widely available, some recent publications illustrate a serious potential failing in this domain: inclusion of refuted science, lack of citation of post-publication correspondence and failure to use ≥1 alternative search strategy. Examples of inadequacies of peer review in medical literature and perpetuation of erroneous science by unfiltered inclusion in subsequent systematic reviews have been identified, and the problem can be traced to authors, peer reviewers, and editors of journals. This perspective identifies and analyzes several possible causes of the problem and recommends some specific corrective actions to improve the quality and accuracy of such reviews.

Quality assessment of systematic reviews and meta-analyses that examine preventive antibiotic uses and management practices designed to prevent disease in livestock.

To implement effective stewardship in food animal production, it is essential that producers and veterinarians are aware of preventive interventions to reduce illness in livestock. Systematic reviews and meta-analyses (SR/MA) provide transparent, replicable, and quality-assessed overviews. At present, it is unknown how many SR/MA evaluate preventive antibiotic use or management practices aimed at reducing disease risk in animal agriculture. Further, the quality of existing reviews is unknown. Our aim was to identify reviews investigating these topics and to provide an assessment of their quality. Thirty-eight relevant reviews were identified. Quality assessment was based on the AMSTAR 2 framework for the critical appraisal of systematic reviews. The quality of most of the reviews captured was classified as critically low (84.2%, n = 32/38), and only a small percentage of the evaluated reviews did not contain critical weaknesses (7.9%, n = 3/38). Particularly, a small number of reviews reported the development of an a priori protocol (15.8%, n = 6/38), and few reviews stated that key review steps were conducted in duplicate (study selection/screening: 26.3%, n = 10/38; data extraction: 15.8%, n = 6/38). The development of high-quality reviews summarizing evidence on approaches to antibiotic reduction is essential, and thus greater adherence to quality conduct guidelines for synthesis research is crucial.

New insulin delivery devices and glycemic outcomes in young patients with type 1 diabetes: a protocol for a systematic review and meta-analysis

BackgroundOptimal type 1 diabetes mellitus (T1D) care requires lifelong appropriate insulin treatment, which can be provided either by multiple daily injections (MDI) of insulin or by continuous subcutaneous insulin infusion (CSII). An increasing number of trials and previous systematic reviews and meta-analyses (SRMA) have compared both CSII and MDI but have provided limited information on equity and fairness regarding access to, and the effect of, those insulin devices. This study protocol proposes a clear and transparent methodology for conducting a SRMA of the literature (1) to assess the effect of CSII versus MDI on glycemic and patient-reported outcomes (PROs) among young patients with T1D and (2) to identify health inequalities in the use of CSII.MethodsThis protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P), the PRISMA-E (PRISMA-Equity 2012 Guidelines), and the Cochrane Collaboration Handbook. We will include randomized clinical trials and non-randomized studies published between January 2000 and June 2019 to assess the effectiveness of CSII versus MDI on glycemic and PROs in young patients with T1D. To assess health inequality among those who received CSII, we will use the PROGRESS framework. To gather relevant studies, a search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews, and the Health Technology Assessment (HTA) database. We will select studies that compared glycemic outcomes (the glycosylated hemoglobin values, severe hypoglycemia episodes, diabetic ketoacidosis events, and/or time spent in range or in hyper-hypoglycemia), and health-related quality of life, as a PRO, between therapies. Screening and selection of studies will be conducted independently by two researchers. Subgroup analyses will be performed according to age group, length of follow-up, and the use of adjunctive technological therapies that might influence glycemic outcomes.DiscussionStudies of the average effects of CSII versus MDI may have not assessed their impact on health equity, as some intended populations have been excluded. Therefore, this study will address health equity issues when assessing effects of CSII. The results will be published in a peer-review journal. Ethics approval will not be needed.Systematic review registrationPROSPERO CRD42018116474

An Overview of Systematic Reviews of Randomized Controlled Trials on Acupuncture Treating Migraine.

Objectives To review the evidence of acupuncture for acute and preventive treatment of migraine for further awareness of the effect of acupuncture for migraine. Design An overview of systematic reviews and meta-analyses (SR/MAs) for randomized controlled trials. Material and Methods We searched PubMed, Embase, the Cochrane Library, China Knowledge Resource Integrated Database, VIP Chinese Journal Full Text Database, WANFANG Data, and China Biology Medicine disc from their establishment to May 27, 2018. SR/MAs of randomized controlled trials comparing the effect of the acupuncture intervention with another treatment control in migraine patients were included. Results 428 SRs were identified, and 15 of them were included. Only 4 SR/MAs were assessed by GRADE, which showed certainty of most evidence being low or very low. Assessed by AMSTAR-2, fourteen was critically low rating overall confidence in the results, and 1 was low rating overall confidence in the results. Evidence suggested that acupuncture has a significant advantage of pain improvement, efficacy, and safety relative to blank control, sham acupuncture, or drug treatment, but some of these results are contradictory. Conclusions We found that acupuncture on treating migraine has the advantage for pain improvement and safety, but the quality of SR/MAs of acupuncture for migraine remains to be improved.

Methodological steps used by authors of systematic reviews and meta-analyses of clinical trials: a cross-sectional study

BackgroundThe quality of systematic reviews and meta-analyses (SR/MAs) depends on the extent of the methods used. We investigated the methodological steps used by authors of SR/MAs of clinical trials via an author survey.MethodsWe conducted an email-based cross-sectional study by contacting corresponding authors of SR/MAs that were published in 2015 and 2016 and retrieved through the PubMed database. The 27-item questionnaire was developed to study the methodological steps used by authors when conducting a SR/MA and the demographic characteristics of the respondent. Besides the demographic characteristics, methodological questions regarding the source, extraction and synthesis of data were included.ResultsFrom 10,292 emails sent, 384 authors responded and were included in the final analysis. Manual searches were carried out by 69.2% of authors, while 87.3% do updated searches, 49.2% search grey literature, 74.9% use the Cochrane tool for risk of bias assessment, 69.8% assign more than two reviewers for data extraction, 20.5% use digital software to extract data from graphs, 57.9% use raw data in the meta-analysis, and 43.8% meta-analyze both adjusted and non-adjusted data. There was a positive correlation of years of experience in conducting of SR/MAs with both searching grey literature (P = 0.0003) and use of adjusted and non-adjusted data (P = 0.006).ConclusionsMany authors still do not carry out many of the vital methodological steps to be taken when performing any SR/MA. The experience of the authors in SR/MAs is highly correlated with use of the recommended tips for SR/MA conduct. The optimal methodological approach for researchers conducting a SR/MA should be standardized.

Effectiveness of Percutaneous Adhesiolysis in Post Lumbar Surgery Syndrome: A Systematic Analysis of Findings of Systematic Reviews

Background: Post lumbar surgery syndrome is common and often results in chronic, persistent pain and disability, which can lead to multiple interventions. After failure of conservative treatment, either surgical treatment or a nonsurgical modality of treatment such as epidural injections, percutaneous adhesiolysis are often contemplated in managing post lumbar surgery syndrome. Multiple previous systematic reviews have reached discordant conclusions about the level of evidence for the effectiveness of percutaneous adhesiolysis in managing post lumbar surgery syndrome and other conditions. Study Design: A systematic review of previously published systematic reviews assessing efficacy of percutaneous adhesiolysis in managing post lumbar surgery syndrome. Objective: To evaluate the value and validity of previous systematic reviews performed after 2015 on effectiveness of percutaneous adhesiolysis in managing chronic refractory low back and lower extremity pain secondary to post lumbar surgery syndrome. Methods: Previous systematic reviews on percutaneous adhesiolysis were evaluated. The quality of each systematic review was assessed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A Measurement Tool to Assess Systematic Reviews (AMSTAR). The randomized trials included in the available systematic reviews were assessed by Cochrane review criteria and Interventional Pain Management techniques - Quality Appraisal of Reliability and Risk of Bias Assessment (IPM-QRB) for methodologic quality. Data sources included relevant systematic reviews and the randomized trials included in those systematic reviews published since 2015 with searches of PubMed, Cochrane reviews, and Google Scholar through February 2019. Outcome Measures: Outcome measures were significant improvement defined as 50% pain relief and improvement in functional status. Short-term efficacy was defined as improvement of 6 months or less, whereas long-term efficacy was defined as more than 6 months. Results: Three systematic reviews and 4 randomized controlled trials (RCTs) of post lumbar surgery syndrome with chronic refractory low back and lower extremity pain showed notable evidence of significant pain relief. Only one systematic review, which was of low quality with inappropriate analysis, showed lack of evidence. Conclusion: Overall, the present analysis shows Level I evidence for percutaneous adhesiolysis based on significant evidence from published RCTs and 3 of the 4 systematic reviews. Key words: Post lumbar surgery syndrome, epidural fibrosis, percutaneous adhesiolysis, systematic reviews, randomized controlled trials

Correlation between gene polymorphism and blood concentration of calcineurin inhibitors in renal transplant recipients: An overview of systematic reviews.

Background:To provide an overview of systematic reviews and meta-analyses (SRs/MAs) of the correlation between genetic polymorphisms and blood concentrations of calcineurin inhibitors (CNIs) in recipients of renal transplant.Methods:Databases including Medline, EMBase, The Cochrane Library (Issue 7, 2016), the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the China Science and Technology Journal Database, and the Wan Fang Database were searched for SRs/MAs of the correlation between genetic polymorphisms and blood concentrations of CNIs in renal transplant recipients from inception to July 2016. Two reviewers independently screened the literatures and extracted data, then the AMSTAR measurement tool was used to assess the methodological quality of SRs/Mas included in the overview.Results:Fourteen SRs/MAs met the inclusion criteria. The most commonly reported genotype was CYP3A5∗3/∗3, which was strongly associated with cyclosporine A (CsA) and tacrolimus (FK506). MDR1 C3435T CC was also associated with CNI use, especially with CsA therapy. Other less commonly reported genotypes such as CYP3A4∗1B, MDR1 C1236T CC, and MDR1 G2677T/A GG also affected the blood concentrations of CNIs.Conclusions:Our overview showed that polymorphisms influence the blood concentrations of CNIs, which suggests the necessity to monitor these concentrations in patients with genotypes that affect dose-adjusted trough concentrations (C0/D) or dose-adjusted peak concentrations (C2/D) to regulate the dosage for individual administration. Because of the limited number of included studies, these findings should be verified in more high-quality studies.

Redundant systematic reviews on the same topic in surgery: a study protocol for a meta-epidemiological investigation

IntroductionWe are witnessing an explosive increase in redundant and overlapping publications of systematic reviews and meta-analyses (SRs/MAs) on the same topic, which often present conflicting results and interpretations, in the...

4.31 TOWARDS IMPROVED SYSTEMATIC REVIEW AND META-ANALYSIS QUALITY IN CHILD AND ADOLESCENT MENTAL HEALTH: A SYSTEMATIC REVIEW

Systematic reviews and meta-analyses (SR/MA) on the prevention and treatment of child and adolescent mental disorders are increasingly available. When conducted using rigorous methodological standards, these knowledge syntheses provide a gold-standard information source that can guide healthcare decision making and inform priorities for future research. Because little attention has been given to documenting and improving their methodological rigor, we applied SR methods to evaluate the quality of SR/MA on the prevention or treatment of child and adolescent anxiety, depression, and suicide.