ObjectivesTo overview the systematic reviews/meta-analyses (SRs/MAs) of effectiveness and safety of spinal manipulation for low back pain or neck pain. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), CBM, CNKI, WanFang Data and VIP to collect SRs/MAs of spinal manipulation for low back pain or neck pain from inception to January 30th, 2015. Two reviewers independently screened literature, extracted data, and then AMSTAR tool was used to assess the methodological quality of included SRs/MAs. ResultsA total of 21 SRs/MAs were included. Twenty of them assessed the methodological quality of included original randomized controlled trials (RCTs) with different tools:2 used Jadad scale, 5 used PEDro scale, 6 used Cochrane bias risk assessment tool and 7 used other tools. The assessment results of AMSTAR tool suggested that:among 11 items, the item 1 of "Was an ‘a priori’ design provided" (18 SRs/MAs did not provide) and item 4 of "Was a list of studies (included and excluded) provided" (18 SRs/MAs did not provide) appeared to be the most problematic, followed by item 10 of "Was the likelihood of publication bias assessed" (14 SRs/MAs did not assess the publication bias) and item 11 of "Was the conflict of interest stated" (14 SRs/MAs did not provide the conflict of interest and 4 were incomplete). ConclusionThe methodological quality of included SRs/MAs is poor. The limited evidence showed that spinal manipulation is more effective for acute low back pain than chronic low back pain, and the short term effect is better than the long term one. Different spinal manipulation techniques have various effects but are all safe. Chiropractic manipulation may have the best effect. Due to the limitation of quality and quantity of included SRs/MAs, there may be potential bias in the above conclusion that needs more high quality studies to verify.
ObjectiveTo evaluate the risk of bias and reliability of conclusions of systematic reviews (SRs) of lung cancer screening. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 2, 2016), Web of Knowledge, CBM, WanFang Data and CNKI to collect SRs of lung cancer screening from inception to February 29th, 2016. The ROBIS tool was applied to assess the risk of bias of included SRs, and then GRADE system was used for evidence quality assessment of outcomes of SRs. ResultsA total of 11 SRs involving 5 outcomes (mortality, detection rate, survival rate, over-diagnosis and potential benefits and harms) were included. The results of risk of bias assessment by ROBIS tool showed:Two studies completely matched the 4 questions of phase 1. In the phase 2, 6 studies were low risk of bias in the including criteria field; 8 studies were low risk of bias in the literature search and screening field; 3 studies were low risk of bias in the data abstraction and quality assessment field; and 5 studies were low risk of bias in the data synthesis field. In the phase 3 of comprehensive risk of bias results, 5 studies were low risk. The results of evidence quality assessment by GRADE system showed:three studies had A level evidence on the outcome of mortality; 1 study had A level evidence on detection; 1 study had A level evidence on survival rate; 3 studies on over-diagnosis had C level evidence; and 2 studies on potential benefits and harms had B level evidence. ConclusionThe risk of bias of SRs of lung cancer screening is totally modest; however, the evidence quality of outcomes of these SRs is totally low. Clinicians should cautiously use these evidence to make decision based on local situation.
ObjectivesTo evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) of lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia. MethodsWe electronically searched databases including PubMed, EMbase, The Cochrane Library, PROSPERO, CNKI, CBM, WanFang Data and VIP to collect systematic reviews and meta-analysis about lanthanum carbonate in the treatment of chronic kidney disease with hyperphosphatemia from inception to August 31st, 2016. Two reviewers independently screened literature and extracted data, then AMSTAR tool was used to assess the methodological quality of included studies and the GRADE tool was used to grade the evidence quality of outcome measures included in the SRs. ResultsA total of eight relevant SRs were included and containing three main outcome measures. The assessment results of AMSTAR tool suggested that:four SRs were of high quality, and the other four were of medium quality. GRADE results showed:for serum phosphorus level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, four SRs were low, low, low and very low; compared with sevelamer, one SR was low. For serum calcium level, compared with placebo, the quality of the evidence of three SRs were high, medium and low, respectively; compared with calcium carbonate or conventional phosphorus binder, five SRs were low, low, low, very low and very low; compared with sevelamer, one SR was very low. For serum iPTH level, compared with placebo, the quality of the evidence of three SRs were medium, low and very low; compared with calcium carbonate or conventional phosphorus binder, five SRs were medium, low, low, very low and very low; compared with sevelamer, one SR was low. ConclusionAt present, methodological quality assessment for the treatment of hyperphosphatemia in chronic kidney disease with lanthanum carbonate is generally not high and the level of evidence for the conclusion is generally low. In drug safety, especially in the occurrence of adverse events of the digestive system is still controversial, and a large amount of high quality experimental is needed to demonstrate the safety of its long-term use. Clinicians need to be cautious in using these evidence to make clinical decisions.
Objectives To overview the systematic reviews/meta-analyses of safety of femoral nerve block (FNB) used as a postoperative analgesic technique in patients undergoing total knee arthroplasty (TKA). Methods We searched databases including The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, and VIP from inception to July, 2016. Two reviewers independently screened literature, extracted data and used AMSTAR to evaluate the methodological quality of the included studies. The major indexes used to evaluate the safety of FNB were the incidence rates of symptoms including nausea, vomiting, sedation, retention of urine, dizziness, pruritus, hypotension, falls, nenous thromboembolism and deep infection. Results A total of 12 systematic reviews/meta-analyses were included.They assessed the safety of FNB compared with local infiltration analgesia (LIA), periarticular multimodal drug injection (PMDI), epidural analgesia (EA), patient-controlled intravenous analgesia of opioids (PCA) and adductor canal block (ACB), respectively. The methodological quality of included studies were medium, with the scores between 3 to 10. The results of overview indicated that: FNB had lower incidence rates of nausea and vomiting compared with EA and PCA, but had higher than ACB. FNB had lower incidence rates of sedation and retention of urine compared with EA and PCA. FNB had lower incidence rates of dizziness compared with EA and PCA, and lower incidence rate of hypotension compared with EA. Conclusion Current evidence suggests that FNB is safer than EA and PCA. Due to the limited quantity and quality of the included studies, the above conclusions are needed to be verified by more high-quality studies.
Objective To overview the systematic reviews about the efficacy and safety of respiratory fluoroquinolones for community-acquired pneumonia (CAP). Methods We electronically searched databases including China National Knowledge Internet, WanFang Data, VIP, PubMed, Embase and The Cochrane Library to collect systematic reviews or Meta-analyses about respiratory fluoroquinolones for CAP from inception to November 2, 2017. Two reviewers independently screened literatures, extracted data, and then AMSTAR tool was used to assess the methodological quality of included studies. Results A total of 18 systematic reviews/Meta-analyses were included. The results of quality assessment indicated the scores ranged from 5 to 10. Among the 11 items, the item 1 of " Was an ‘a priori’ design provided” and item 4 " Was the status of publication (i.e. grey literature) used as an inclusion criterion” appeared to be the most problematic. The results of overview suggested that: the efficacy of respiratory fluoroquinolones might be similar to β-lactams plus macrolides combination treatment for CAP. However, respiratory fluoroquinolones might be more safety. In addition, the efficacy of respiratory fluoroquinolones sequential therapy for CAP was similar to that of continuous intravenous therapy, but the adverse reactions of the former were fewer. Conclusions Respiratory fluoroquinolones might be similar in efficacy for CAP to other antibiotics recommended by the guidelines with less adverse reactions. However, it can increase multi-drug resistance and potential tuberculosis drug resistance, we should strictly follow the principle of rational use of antibiotics to avoid abuse.
ObjectivesTo survey the systematic reviews of pharmacoeconomic evaluations.MethodsDatabases including The Cochrane Library, PubMed, EMbase (Ovid), NHS EED (Ovid), CENTRAL, Health Technology Assessment (HTA) Database, CNKI, WanFang Data, VIP and CBM were searched from inception to May 2018 to collect systematic reviews of pharmacoeconomic evaluations. Two reviewers independently screened literature and extracted data. Data statistics and frequency analysis were then conducted on the basic characteristics of included literatures, which involves the publication journal type and influencing factors (IF), disease type, quality assessment tool, etc. The amended AMSTAR scale was used to assess the methodological quality of pharm-SR.ResultsOne hundred and forty-three systematic reviews were included in the overview. The UK had a large number of publications (39.8%), which were mostly published in the Health Technology Assessment and Pharmacoeconomics. Among the included literatures, most were evaluated tumor related pharmacoeconomics systematic reviews (20.8%). They searched on average 7.42±4.00 databases. The British Medical Journal checklist (20.15%) and the Drummond checklist (19.40) were the main tools for quality evaluation. The methodological qualities of these studies were not high.ConclusionsThe evidence shows that the number of systematic reviews of pharmacoeconomic is increasing and research methodology is gradually unifying. However, the quality is still required to be further improved.
ObjectivesTo conduct an overview of systematic reviews (SRs) on Tuina from 2013 to 2017, and to explore recent research improvements on Tuina.MethodsPubMed, Web of Science, The Cochrane Library, SpringerLink e-book database, CNKI, VIP, WanFang Data and CBM databases were searched to collect SRs including randomized controlled clinical trials on Tuina from January 1st, 2013 to December 31st, 2017. Two reviewers independently screened literature, extracted data, and used AMSTAR 2 tool and PRISMA statement to assess methodology quality and reporting quality of included studies, respectively. The R 3.4.3 software was used to analyze data.ResultsA total of 8 SRs studies were included in the overview. The studied diseases involved radiculopathy cervical spondylotic, myelopathy cervical spondylotic, constipation, child anorexia, child diarrhea and external humeral epicondylitis. The results of above SRs showed that massage might be superior to other interventions in clinical efficacy, curative effects or total effective rate. However, due to the low quality of included studies of SRs, further evidence from high-quality clinical studies is required to verify above conclusions. For the results of AMSTAR 2 assessment, all 8 SRs were rated as very low quality. The quantity of items accomplished for each SR ranged from 7 to 13, 2 SRs had low methodological quality (percentage of accomplishment or partial accomplishment <50.0%) and 6 SRs with high methodological quality (percentage of accomplishment or partial accomplishment ≥50.0%). All 8 SRs did not report item 2 "Whether to declare research methods", item 10 "Whether reports have included funding sources for each study" and item 11 "Whether reports used the correct statistical method". The results of PRISMA assessment showed that all SR had good quality of reporting. The accomplished items number of each SR ranged from 22 to 26. However, there were defects in item 5(0), item 16(25.0%) and item 23(25.0%). All SRs did not report item 5 "Whether to declare research program".ConclusionsThis study finds that Tuina has supportive evidence-based medical evidence for treating anorexia, cervical spondylosis and other diseases, however, the SRs of Tuina are yet needed to be improved in terms of standardized degree. Therefore, establishing a reporting consolidated standard for evidence-based medicine on Tuina in order to improve the quality of clinical studies so as to provide clinicians with high-quality evidence is the focus of our further research.
ObjectivesTo evaluate the quality of methodology and evidence of the exiting systematic reviews (SRs) of acupuncture therapy for post-stroke spastic paralysis.MethodsCNKI, CBM, The Cochrane Library, PubMed and EMbase databases were electronically searched to collect SRs of acupuncture therapy for post-stroke spastic paralysis from inception to December 16th, 2018. Two reviewers independently screened literature, extracted data, and evaluated the quality of methodology and evidence by AMSTAR 2 scale and GRADE system.ResultsA total of 7 SRs were included. The results showed that acupuncture therapy had obvious advantages in treating post-stroke spastic paralysis without obvious adverse reactions. The results of AMSTAR 2 scale showed that the failure of key items 2 and 7 resulted in extremely low methodological quality. The results of GRADE system showed that 46.15% of which were low-level evidence quality, 42.31% were medium, 11.54% were extremely low, and no evidence quality were high.ConclusionsCurrent evidence shows that acupuncture and moxibustion therapy is effective in treating spastic paralysis after stroke, however, the quality of the SRs is low. The studies are required to be standardized and combined with the characteristics of TCM to obtain high quality evidence in the future.
ObjectiveTo overview the systematic reviews on efficacy and safety of hyperbaric oxygen in treatment of diabetic foot.MethodsCNKI, CBM, VIP, WanFang Data, The Cochrane Library, PubMed and EMbase databases were searched to collect systematic reviews or meta-analyses on the efficacy and safety of hyperbaric oxygen therapy for diabetic foot from inception to November 17th, 2019. Two researchers independently screened literature and extracted data. Then, AMSTAR 2 tool and PRISMA statement were used to evaluate the methodological quality and reporting quality of included systematic reviews, and the outcome indicators were comprehensively analyzed.ResultsA total of 10 systematic reviews were included. The results of AMSTAR 2 suggested that 6 systematic reviews were of extremely low quality, 3 of low quality, and 1 of high quality. The PRISMA score ranged from 16.5 to 27. The results of the included systematic reviews showed that hyperbaric oxygen therapy might be superior to other interventions in ulcer healing rate and large amputation rate without increasing the risk of adverse events. ConclusionsThe existing systematic reviews/meta-analysis evidence shows that hyperbaric oxygen therapy may have certain curative effect on diabetic foot, however, its methodology and report quality evaluation are insufficient.
Objective To overview the systematic reviews of the effectiveness and safety of the charged-particle radiation therapy. Methods Databases including CNKI, WanFang Data, PubMed, and EMbase were electronically searched from January 2007 to November 2020. Two investigators independently screened literature, extracted data, and assessed the quality of the included studies by AMSTAR 2, and then reported results through a narrative synthesis of outcomes. Results A total of 6 systematic reviews were identified. One systematic review demonstrated moderate quality and the other 5 demonstrated critically low quality. The charged-particle radiation therapy had a wide range of applications. Its effectiveness was superior to traditional radiotherapy methods on various types of tumors in various regions of the body, with acceptable side effects. Specifically, the effectiveness and safety outcomes of carbon ion radiotherapy was superior to those of proton radiotherapy. Conclusions Current evidence shows that the charged-particle radiation therapy has superior effectiveness and limited toxicity, though the studies are of relatively low quality. High quality and larger sample size researches are required in the future.