Systematic Review Of Adverse Effects Research Articles

The role of exercise in the management of adverse effects of androgen deprivation therapy for prostate cancer: a rapid review.

Prostate cancer (PCa) is the most commonly diagnosed cancer in Australia, accounting for one quarter of all new cancer diagnoses for males. Androgen deprivation therapy (ADT) is the standard first-line therapy for metastatic PCa but is also used across much of the spectrum of disease. Unfortunately, debilitating adverse effects are a significant and largely unavoidable feature of ADT. A recent systematic review of adverse effects of ADT identified 19 sub-groups classified according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. The potential for multiple simultaneous adverse effects, their associated management and the impact of adverse effects on cancer outcomes and quality of life are important considerations in the treatment and supportive care of men with PCa. Exercise is increasingly being recognized as an efficacious strategy in managing these adverse effects. A rapid review was undertaken to examine the role of exercise in the management of the most commonly reported ADT adverse effects classified according to the CTCAE sub-groups. A systematic search was conducted in Medline, PsycINFO, Google Scholar and Google for the years 2010 to September 2019 to identify the benefits of exercise in managing the adverse effects of ADT for PCa. There is strong evidence for exercise as medicine in addressing several of the adverse effects of PCa such as loss of muscle mass and strength, fatigue and declining physical function. Moderate level evidence for PCa exists for exercise-induced improvements in depression and anxiety, bone loss, and sexual dysfunction. While evidence of the effectiveness of exercise is lacking for many adverse effects of ADT for PCa, evidence in the cancer population as a whole or other clinical populations is strong, and many clinical guidelines recommend exercise as a fundamental part of their clinical management. With the exception of gynaecomastia and breast pain, there is increasing evidence (PCa, cancer or other clinical populations) to suggest that exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. Exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. The use of exercise for PCa management has the potential to translate into health and economic benefits in improved quality of life and fewer complications, resulting in savings to the health care system, enhanced productivity and reduced patient and carer burden. Exercise thus has the potential to improve quality of life for this population as well as generate significant cost savings.

Working with Inadequate Tools: Legislative Shortcomings in Protection against Ecological Effects of Artificial Light at Night

The fundamental change in nocturnal landscapes due to the increasing use of artificial light at night (ALAN) is recognized as being detrimental to the environment and raises important regulatory questions as to whether and how it should be regulated based on the manifold risks to the environment. Here, we present the results of an analysis of the current legal obligations on ALAN in context with a systematic review of adverse effects. The legal analysis includes the relevant aspects of European and German environmental law, specifically nature conservation and immission control. The review represents the results of 303 studies indicating significant disturbances of organisms and landscapes. We discuss the conditions for prohibitions by environmental laws and whether protection gaps persist and, hence, whether specific legislation for light pollution is necessary. While protection is predominantly provided for species with special protection status that reveal avoidance behavior of artificially lit landscapes and associated habitat loss, adverse effects on species and landscapes without special protection status are often unaddressed by existing regulations. Legislative shortcomings are caused by difficulties in proving adverse effect on the population level, detecting lighting malpractice, and applying the law to ALAN-related situations. Measures to reduce ALAN-induced environmental impacts are highlighted. We discuss whether an obligation to implement such measures is favorable for environmental protection and how regulations can be implemented.

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review.

Androgen deprivation therapy (ADT) has broad application in the treatment of prostate cancer (PC) and is associated with numerous, debilitating adverse effects. Increasing use of ADT for PC, longer timeframe for treatment (increased uptake of PSA testing and earlier diagnosis), as well as improved survival and an ageing population, means patients can live for a considerable period of time on or after ADT, experiencing these adverse effects. A number of systematic reviews of adverse effects of ADT for PC exist; however, no single systematic review has previously examined the evidence for all adverse effects, including newer forms of ADT. A systematic review of existing systematic reviews of ADT for PC was conducted (2010-February 2019), as per Cochrane guidelines, to identify the highest level of risk/incidence evidence available, supplemented by evidence drawn from individual studies where no systematic review existed. Incidence data was generated for 19 adverse effect subgroups, classified according to the common terminology criteria for adverse events (CTCAE). Incidence of adverse effects provides valuable information for future burden of disease studies. This information can better guide clinical management to reduce symptoms for patients and assist patients to make more informed decisions about their treatment, potentially improving disease outcomes. It also highlights the importance of supportive care for PC patients receiving ADT and their carers. For analysts conducting economic evaluations, the inclusion of adverse effects in PC decision analytic models can provide more comprehensive and accurate information for decision makers.

Naming Specific Adverse Effects Improves Relative Recall for Search Filters Identifying Literature on Surgical Interventions in MEDLINE and Embase

A Review of:
 Golder, S., Wright, K., & Loke, Y.K. (2018). The development of search filters for adverse effects of surgical interventions in MEDLINE and Embase. Health Information and Libraries Journal, 35(2), 121-129. https://doi.org/10.1111/hir.12213
 Abstract
 Objective – “To develop and validate search filters for MEDLINE and Embase for the adverse effects of surgical interventions” (p.121).
 Design – From a universe of systematic reviews, the authors created “an unselected cohort…where relevant articles are not chosen because of the presence of adverse effects terms” (p.123). The studies referenced in the cohort reviews were extracted to create an overall citation set. From this, three equal-sized sets of studies were created by random selection, and used for: development of a filter (identifying search terms); evaluation of the filter (testing how well it worked); and validation of the filter (assessing how well it retrieved relevant studies).
 Setting – Systematic reviews of adverse effects from the Database of Abstracts of Reviews of Effects (DARE), published in 2014.
 Subjects – 358 studies derived from the references of 19 systematic reviews (352 available in MEDLINE, 348 available in Embase).
 Methods – Word and phrase frequency analysis was performed on the development set of articles to identify a list of terms, starting with the term creating the highest recall from titles and abstracts of articles, and continuing until adding new search terms produced no more new records recalled. The search strategy thus developed was then tested on the evaluation set of articles. In this case, using the strategy recalled all of the articles which could be obtained using generic search terms; however, adding specific search terms (such as the MeSH term “surgical site infection”) improved recall. Finally, the strategy incorporating both generic and specific search terms for adverse effects was used on the validation set of articles. Search strategies used are included in the article, as is a list in the discussion section of MeSH and Embase indexing terms specific to or suggesting adverse effects.
 Main Results – “In each case the addition of specific adverse effects terms could have improved the recall of the searches” (p. 127). This was true for all six cases (development, evaluation and validation study sets, for each of MEDLINE and Embase) in which specific terms were added to searches using generic terms, and recall percentages compared.
 Conclusion – While no filter can deliver 100% of items in a given standard set of studies on adverse effects (since title and abstract fields may not contain any indication of relevance to the topic), adding specific adverse effects terms to generic ones while developing filters is shown to improve recall for surgery-related adverse effects (similarly to drug-related adverse effects). The use of filters requires user engagement and critical analysis; at the same time, deploying well-constructed filters can have many benefits, including: helping users, especially clinicians, get a search started; managing a large and unwieldy set of citations retrieved; and to suggest new search strategies.

Most systematic reviews of adverse effects did not include unpublished data

ObjectivesWe sought to identify the proportion of systematic reviews of adverse effects which search for unpublished data and the success rates of identifying unpublished data for inclusion in a systematic review. Study Design and SettingTwo reviewers independently screened all records published in 2014 in the Database of Abstracts of Reviews of Effects (DARE) for systematic reviews where the primary aim was to evaluate an adverse effect or effects. Data were extracted on the types of adverse effects and interventions evaluated, sources searched, how many unpublished studies were included, and source or type of unpublished data included. ResultsFrom 9,129 DARE abstracts, 348 met our inclusion criteria. Most of these reviews evaluated a drug intervention (237/348, 68%) with specified adverse effects (250/348, 72%). Over a third (136/348, 39%) of all the reviews searched, a specific source for unpublished data, such as conference abstracts or trial registries, and nearly half of these reviews (65/136, 48%) included unpublished data. An additional 13 reviews included unpublished data despite not searching specific sources for unpublished studies. Overall, 22% (78/348) of reviews included unpublished data/studies. ConclusionMost reviews of adverse effects do not search specifically for unpublished data but, of those that do, nearly half are successful.

Systematic Review of Adverse Effects from Herbal Drugs Reported in Randomized Controlled Trials.

Herbal drugs have become a popular form of healthcare, raising concerns about their safety. This study aimed to characterize the adverse effects of herbal drugs through a systematic review of results reported in randomized controlled trials (RCTs). Using eight electronic databases including PubMed, the Cochrane library and six Korean medical databases, the frequency of reported toxicity was recorded based on drug composition and indication. Among 4957 potentially relevant articles, 242 papers comprised of 244 studies met our inclusion criteria; these included 111 studies of a single herb and 133 of multiple herbs. These studies accounted for a total 15 441 participants (male = 5590; female = 9851; 7383 for single and 8058 for multiple herb studies). There were 480 cases (3.1%) of adverse events (344 for single, 136 for multiple herb studies; p < 0.01). A total of 259 cases reported blood test abnormalities, including five cases of abnormality in hepatic functional enzymes. The most frequently reported adverse event was digestive symptoms (44.3%), followed by nervous system symptoms (17.3%) and behaviors such as loss of appetite (16.3%). This is the first systematic review of adverse effects of herbal drugs among clinical studies, and the results indicate that herbal drugs are relatively safe. Copyright © 2016 John Wiley & Sons, Ltd.

Systematic Review of Adverse Effects: A Further Step towards Modernization of Acupuncture in China.

As a further step towards the modernization of acupuncture, the objective of this review was to figure out the frequency and severity of adverse complications and events in acupuncture treatment reported from 1980 to 2013 in China. All first-hand case reports of acupuncture-related complications and adverse events that could be identified in the scientific literature were reviewed and classified according to the type of complication and adverse event, circumstance of the event, and long-term patient outcome. The selected case reports were published between 1980 and 2013 in 3 databases. Relevant papers were collected and analyzed by 2 reviewers. Over the 33 years, 182 incidents were identified in 133 relevant papers. Internal organ, tissue, or nerve injury is the main complications of acupuncture especially for pneumothorax and central nervous system injury. Adverse effects also included syncope, infections, hemorrhage, allergy, burn, aphonia, hysteria, cough, thirst, fever, somnolence, and broken needles. Qualifying training of acupuncturists should be systemized and the clinical acupuncture operations should be standardized in order to effectively prevent the occurrence of acupuncture accidents, enhance the influence of acupuncture, and further popularize acupuncture to the rest of the world.

Postpartum urinary retention: a systematic review of adverse effects and management.

Postpartum urinary retention (PUR) is a well-known condition after childbirth. Often clinicians assume that this condition is transient, either through belief or by not being aware that its occurrence as measurement of post-void residual volume (PVRV) is often not routine. However, long lasting urinary retention is a serious condition that needs management in order to prevent urogenital tract morbidity. By performing a systematic review of the adverse effects of PUR and management of this condition, we aimed to identify the necessity of diagnosing this condition in the puerperium and to evaluate whether treatment is required. We searched for all studies on PUR in OVID MEDLINE, OVID EMBASE, and ongoing Trial registers. Two reviewers independently screened and extracted the data. Twenty-four papers were included in this review. Limited data on adverse effects demonstrate potential morbidities, like micturition symptoms and sporadically spontaneous bladder ruptures, related to PUR. Based on current literature, evidence stating that PUR is harmless is lacking. Future research should focus on management strategies for overt PUR and the long-term consequences of covert PUR. Until these results are available, clinicians should be aware of the potential consequences and therefore keep trying to identify patients at risk of PUR and patients with the actual condition.

Comparison of search strategies in systematic reviews of adverse effects to other systematic reviews.

Research indicates that the methods used to identify data for systematic reviews of adverse effects may need to differ from other systematic reviews. To compare search methods in systematic reviews of adverse effects with other reviews. The search methodologies in 849 systematic reviews of adverse effects were compared with other reviews. Poor reporting of search strategies is apparent in both systematic reviews of adverse effects and other types of systematic reviews. Systematic reviews of adverse effects are less likely to restrict their searches to MEDLINE or include only randomised controlled trials (RCTs). The use of other databases is largely dependent on the topic area and the year the review was conducted, with more databases searched in more recent reviews. Adverse effects search terms are used by 72% of reviews and despite recommendations only two reviews report using floating subheadings. The poor reporting of search strategies in systematic reviews is universal, as is the dominance of searching MEDLINE. However, reviews of adverse effects are more likely to include a range of study designs (not just RCTs) and search beyond MEDLINE.

Safety and tolerability of antipsychotic polypharmacy

Introduction: Antipsychotic polypharmacy (APP), the concomitant use of ≥ 2 antipsychotics, is common in clinical practice. Prior reviews have focused on the efficacy of APP, but no systematic review exists regarding the safety and tolerability of this practice.Areas covered: A systematic review of adverse effects associated with APP was conducted to prepare this review; case series with ≥ 2 patients, chart reviews, naturalistic, database, cohort and randomized studies that reported on the association between APP in general or specific APP combinations and global or specific adverse effect were included. Methodological limitations of available studies are discussed and recommendations for clinicians and future research are provided.Expert opinion: Across mostly small and uncontrolled studies, APP has been associated with increased global side effect burden, rates of Parkinsonian side effects, anticholinergic use, hyperprolactinemia, sexual dysfunction, hypersalivation, sedation/somnolence, cognitive impairment and diabetes. Effects on akathisia and mortality were inconclusive. Although some combinations, particularly aripiprazole augmentation of an agent with greater side effect burden, may reduce weight gain, dyslipidemia, hyperprolactinemia and sexual dysfunction, APP should remain a last-resort treatment option after monotherapy, switching and non-antipsychotic combinations have failed. More data are needed to further inform the individualized risk–benefit evaluation of APP.

The performance of adverse effects search filters in MEDLINE and EMBASE

Search filters can potentially improve the efficiency of searches involving electronic databases such as medline and embase. Although search filters have been developed for identifying records that contain adverse effects data, little is known about the sensitivity of such filters. This study measured the sensitivity of using available adverse effects filters to retrieve papers with adverse effects data. A total of 233 included studies from 26 systematic reviews of adverse effects were used for analysis. Search filters from medline and embase were tested for their sensitivity in retrieving the records included in these reviews. In addition, the sensitivity of each individual search term used in at least one search filter was measured. Subheadings proved the most useful search terms in both medline and embase. No indexing terms in medline achieved over 12% sensitivity. The sensitivity of published search filters varied in medline from 3% to 93% and in embase from 57% to 97%. Whether this level of sensitivity is acceptable will be dependent on the purpose of the search. Although no adverse effects search filter captured all the relevant records, high sensitivity could be achieved. Search filters may therefore be useful in retrieving adverse effects data.

Meta-analyses of Adverse Effects Data Derived from Randomised Controlled Trials as Compared to Observational Studies: Methodological Overview

There is considerable debate as to the relative merits of using randomised controlled trial (RCT) data as opposed to observational data in systematic reviews of adverse effects. This meta-analysis of meta-analyses aimed to assess the level of agreement or disagreement in the estimates of harm derived from meta-analysis of RCTs as compared to meta-analysis of observational studies. Searches were carried out in ten databases in addition to reference checking, contacting experts, citation searches, and hand-searching key journals, conference proceedings, and Web sites. Studies were included where a pooled relative measure of an adverse effect (odds ratio or risk ratio) from RCTs could be directly compared, using the ratio of odds ratios, with the pooled estimate for the same adverse effect arising from observational studies. Nineteen studies, yielding 58 meta-analyses, were identified for inclusion. The pooled ratio of odds ratios of RCTs compared to observational studies was estimated to be 1.03 (95% confidence interval 0.93-1.15). There was less discrepancy with larger studies. The symmetric funnel plot suggests that there is no consistent difference between risk estimates from meta-analysis of RCT data and those from meta-analysis of observational studies. In almost all instances, the estimates of harm from meta-analyses of the different study designs had 95% confidence intervals that overlapped (54/58, 93%). In terms of statistical significance, in nearly two-thirds (37/58, 64%), the results agreed (both studies showing a significant increase or significant decrease or both showing no significant difference). In only one meta-analysis about one adverse effect was there opposing statistical significance. Empirical evidence from this overview indicates that there is no difference on average in the risk estimate of adverse effects of an intervention derived from meta-analyses of RCTs and meta-analyses of observational studies. This suggests that systematic reviews of adverse effects should not be restricted to specific study types. Please see later in the article for the Editors' Summary.

Critique of review of deaths after chiropractic, 1

To the Editor: It is widely acknowledged that the methodology and reporting of systematic reviews of adverse effects need to improve (1). Part of the problem is that data about harm are rarely found in randomised clinical trials (RCTs) so that identifying important harms of treatment often require a broad range of data sources, including cohort studies, case–control studies, case series and case reports. As all such studies are subject to bias to a greater extent than RCTs, their findings must be interpreted with caution (2). Given the above, we read with interest the systematic review titled, ‘Deaths after chiropractic: a review of published cases’ (3), by Professor Edzard Ernst. Ernst states in the introduction to his review that, ‘The aim of this study was to summarise all cases in which chiropractic spinal manipulation was followed by death.’ We reviewed Professor Ernst’s article and went to both primary and secondary sources in the peer-reviewed literature to double check the professional identity of the care providers in the 26 cases that he reported finding. We found that in three separate cases, Ernst incorrectly assigned the care associated with death to a chiropractor. The following is a summary of our findings: ‘Regarding the case documented by Schmitt (Reference 11 in Ernst’s review), Terrett (4) states, ‘The original paper reports a heilpraktiker (health practitioner)…’’ ‘Regarding the case documented by Mas et al. (Reference 19 in Ernst’s review), Terrett (4) states, ‘Personal correspondence with Professor Mas (Letter, 1st June 1993) reveals that he is not sure of the professional background of the practitioner involved’.’ ‘Ernst states that one death caused by care delivered by a chiropractor was documented by Dziewas et al. (Reference 27 in Ernst’s review). However, Dziewas in an exchange of letters to the editor (5,6) stated,’ ‘We acknowledge that we do not know whether the patients in question had received prior treatment by a ‘duly licensed chiropractor’ or by a ‘briefly trained chiropractitioner’… Chiropractors as in the USA represent a small minority in Germany, the influence of which can be neglected in our cohort … it would indeed have been wise to use the unspecified term ‘manipulation of the cervical spine’ instead of ‘chiropractic manipulation’.’ In the conclusion to his review Ernst states that he believes, ‘There are reasons to suspect that under-reporting (of death due to manipulation by chiropractors) is substantial…’ Ernst, however, by incorrectly labelling care providers as chiropractors in three separate cases, has added to the over-reporting of deaths associated with chiropractic care. It should be noted that in all three cases the fact that the care providers were not chiropractors is easily confirmed by checking primary and/or secondary data sources readily accessible from the peer-reviewed literature. It is interesting that all three of the errors that Ernst made, in assigning professional identity, were errors that increased the apparent association between chiropractors and death. In general, the quality of systematic reviews of adverse effects might be improved by including a systematic means by which to deal with the biases inherent in many of the non-RCT data sources often included in such reviews. A logical place to start in developing a systematic means by which to deal with such biases would be to search for and review secondary data sources in the peer-reviewed literature. None. AW and MB both contributed to the conception and content of the letter. Both authors read and reviewed the related systematic review. AW acquired data from primary and secondary sources. AW and MB contributed to drafts of the letter and both authors revised, suggested modifications and approved the final version to be submitted for publication.

Systematic reviews of adverse effects of drug interventions: a survey of their conduct and reporting quality

There is a need for high quality evidence on the adverse effects of medical interventions to inform policy, practice and research. Methods to systematically review adverse effects have not been fully developed. We aimed to assess the current methods and reporting used by such reviews. Survey of general medical, drug safety and pharmacology journals published in 2006. Methods including: searching, inclusion criteria, quality assessment and meta-analysis were assessed. Forty three systematic reviews from 2704 abstracts in 16 journals were included. The search strategy was not reported by 10 (23%) of reviews. The collection and reporting of the adverse effects from primary studies was described by 4/37 (12%) reviews and the quality of included studies was assessed by 15 (35%) of reviews. Meta-analysis on rare outcomes and handling of zero event data were inconsistent. A polarity in the standard of reporting between reviews was observed. The reporting standard we found was similar to another survey of systematic reviews. Reporting was poor with respect to searching and definition/collection of adverse effects and guidelines such as QUOROM and MOOSE could be employed by authors. Comprehensive and clear reporting should be enforced by journals. The low proportion of reviews assessing quality, and the inconsistencies observed when modelling rare event data reflect the need for empirical research to underpin methods in these areas.

Systematic reviews of adverse effects: framework for a structured approach

BackgroundAs every healthcare intervention carries some risk of harm, clinical decision making needs to be supported by a systematic assessment of the balance of benefit to harm. A systematic review that considers only the favourable outcomes of an intervention, without also assessing the adverse effects, can mislead by introducing a bias favouring the intervention.Much of the current guidance on systematic reviews is directed towards the evaluation of effectiveness; but this differs in important ways from the methods used in assessing the safety and tolerability of an intervention. A detailed discussion of why, how and when to include adverse effects in a systematic review, is required.MethodsThis discussion paper, which presupposes a basic knowledge of systematic review methodology, was developed by consensus among experienced reviewers, members of the Adverse Effects Subgroup of The Cochrane Collaboration, and supplemented by a consultation of content experts in reviews methodology, as well as those working in drug safety.ResultsA logical framework for making decisions in reviews that incorporate adverse effects is provided. We explore situations where a comprehensive investigation of adverse effects is warranted and suggest strategies to identify practicable and clinically useful outcomes. The advantages and disadvantages of including observational and experimental study designs are reviewed. The consequences of including separate studies for intended and unintended effects are explained. Detailed advice is given on designing electronic searches for studies with adverse effects data. Reviewers of adverse effects are given general guidance on the assessment of study bias, data collection, analysis, presentation and the interpretation of harms in a systematic review.ConclusionReaders need to be able to recognize how strategic choices made in the review process determine what harms are found, and how the findings may affect clinical decisions. Researchers undertaking a systematic review that incorporates adverse effect data should understand the rationale for the suggested methods and be able to implement them in their review.

Identifying systematic reviews of the adverse effects of health care interventions

BackgroundIn order to carry out a methodological research survey of systematic reviews of adverse effects we needed to retrieve a sample of systematic reviews in which the primary outcome is an adverse effect or effects.MethodsWe carried out searches of the Database of s of Reviews of Effects (DARE) and the Cochrane Database of Systematic Reviews (CDSR) for systematic reviews of adverse effects published between 1994 to 2005. The search strategies used a combination of text words in the title and abstract, Medical Subject Headings (MeSH) and subheadings/qualifiers. In addition, DARE records in progress were hand searched. No language restrictions were placed on any of the searches. The performance, in terms of sensitivity and precision, of the search strategies and their combinations were tested in DARE and CDSR.ResultsIn total 3635 records were screened of which 257 met our inclusion criteria. The precision of the searches in CDSR was low (0% to 3%), and no one search strategy could retrieve all the relevant records in either DARE or CDSR. Hand searching the records from DARE and CDSR not retrieved by our searches indicated that we had missed relevant systematic reviews in both DARE and CDSR. The sensitivities of many of the search combinations were comparable to those found when searching for primary studies in which adverse effects are secondary outcomes.ConclusionSearching major databases of systematic reviews, for systematic reviews of adverse effects, proved more difficult than anticipated due to a lack of standard terminology used by the authors, inadequate indexing and the variations in the search interfaces of the databases. At present hand searching all records in DARE and CDSR seems to be the only way to ensure retrieval of all systematic reviews of adverse effects in these databases.

Room for improvement? A survey of the methods used in systematic reviews of adverse effects

BackgroundAlthough the methods for conducting systematic reviews of efficacy are well established, there is much less guidance on how systematic reviews of adverse effects should be performed.MethodsIn order to determine where methodological research is most needed to improve systematic reviews of adverse effects of health care interventions, we conducted a descriptive analysis of systematic reviews published between 1994 and 2005. We searched the Database of s of Reviews of Effects (DARE) and The Cochrane Database of Systematic Reviews (CDSR) to identify systematic reviews in which the primary outcome was an adverse effect or effects. We then extracted data on many of the elements of the systematic review process including: types of interventions studied, adverse effects of interest, resources searched, search strategies, data sources included in reviews, quality assessment of primary data, nature of the data analysis, and source of funding.Results256 reviews were included in our analysis, of which the majority evaluated drug interventions and pre-specified the adverse effect or effects of interest. A median of 3 resources were searched for each review and very few reviews (13/256) provided sufficient information to reproduce their search strategies. Although more than three quarters (185/243) of the reviews sought to include data from sources other than randomised controlled trials, fewer than half (106/256) assessed the quality of the studies that were included. Data were pooled quantitatively in most of the reviews (165/256) but heterogeneity was not always considered. Less than half (123/256) of the reviews reported on the source of funding.ConclusionThere is an obvious need to improve the methodology and reporting of systematic reviews of adverse effects. The methodology around identification and quality assessment of primary data is the main concern.

A Systematic Review of Adverse Effects Associated with Topical Treatments for Psoriasis

Mild to moderate psoriasis is a disease that can often be treated with topical medications. The diversity of topical therapies and their disparate side effects complicates treatment planning. Our purpose is to compare the rates of adverse events associated with different topical psoriasis treatments. A review of medical literature from 1996 to March, 2002 was conducted using guidelines set by QUORUM statement criteria. In monotherapy studies, corticosteriods caused fewer adverse reactions compared to vitamin D analogues and tazarotene. In combination studies adverse event rates were higher than in monotherapy studies, except for the combination of topical steroid and calcipotriene which decreased irritation. Irritant contact dermatitis was the main side effect with vitamin D analogues, tazarotene, dithranol or coal tar, while side effects of topical corticosteriods included headache, viral infection and skin atrophy. Topical agents for psoriasis are usually well-tolerated without severe side effects. Formulating a patient's medication regimen should take into account the needs for short-term management and long-term control of psoriasis. Since clearance is not a realistic expectation, reasonable goals should be set as excessive use of topical treatments may increase the risk of both cutaneous and systemic side effects.

Panax ginseng: a systematic review of adverse effects and drug interactions

Focus on Alternative and Complementary TherapiesVolume 7, Issue 1 p. 111-112 Panax ginseng: a systematic review of adverse effects and drug interactions J Thompson Coon, J Thompson Coon Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorE Ernst, E Ernst Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this author J Thompson Coon, J Thompson Coon Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this authorE Ernst, E Ernst Department of Complementary Medicine, University of Exeter, 25 Victoria Park Road, Exeter, EX2 4NT, UKSearch for more papers by this author First published: 14 June 2010 https://doi.org/10.1111/j.2042-7166.2002.tb03399.xCitations: 4Read the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume7, Issue1March 2002Pages 111-112 RelatedInformation