ObjectiveTo overview the systematic reviews of the efficacy of cancer patient decision aids (PDAs) for treatment decision-making. MethodsThe PubMed, Web of Science, Cochrane Library, Embase, CINAHL, JBI, CNKI, VIP, CBM and WanFang Data databases were electronically searched to collect the systematic reviews relevant to the objective from inception to September 2023. Literature screening, data extraction, methodological quality assessment of the included literature, and summary and grading of the evidence were carried out independently by two researchers, and duplication of original studies in the included systematic evaluations was investigated using the corrected covered area (CCA). ResultsA total of 17 systematic reviews were included, of which 13 (76.47%) were low- or very low-quality studies. A total of 64 pieces of evidence were included, of which only 26 (40.62%) were of moderate quality, and the original studies included in the included literature had a low degree of overlap (CCA=0.05). The results of meta-analysis showed that PDAs could increase decision-related knowledge, reduce decision conflict and regret in cancer patients' treatment decision (P<0.05). However, there was no significant difference in decision satisfaction, anxiety or depression (P>0.05). ConclusionPDAs can improve cancer patients' knowledge related to treatment decision, reduce decision conflicts and regrets, and have no significant negative effects on decision preparation, satisfaction, anxiety, and depression. However, the existing systematic reviews are of low quality and limited to a few cancer types.
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.
ObjectiveTo assess the methodological quality of systematic reviews of Tai Chi for preventing falls in the elderly and the quality of evidence for outcome indicators.MethodsPubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang Data, CBM and VIP databases were electronically retrieved. According to the inclusion criteria and exclusion criteria, the final articles were selected and the relevant literature information was extracted by reading the abstract and the full text. The methodological quality of the included systematic reviews was evaluated using AMSTAR 2 tool, and the quality of the outcome indicators of the included systematic reviews was further graded according to the GRADE system.ResultsA total of 11 systematic reviews/meta-analyses were included. The AMSTAR 2 evaluation showed that 10 studies were in critically-low methodological quality, and 1 study was in low methodological quality. The GRADE evaluation results showed that among the 36 outcome indicators included, there were 10 intermediate quality indicators, 20 low-level quality indicators and 6 extremely low-level quality indicators. Among the indicators of intermediate quality, single-leg stand test (MD = 5.33, 95%CI 3.35 to 7.32, P< 0.01; WMD = 1.76, 95%CI −7.00 to 10.52, P< 0.01), time up and go test (MD = 1.04, 95%CI 0.67 to 1.41, P< 0.01), the berg balance scale (MD = 2.18, 95%CI 0.93 to 3.43, P< 0.01), number of falls (RR = 0.82, 95%CI 0.73 to 0.92), P< 0.01), the incidence of 2-falls (OR = 0.69, 95%CI 0.49 to 0.97, P< 0.01) and the incidence of 3-falls (OR = 0.39, 95%CI 0.21 to 0.73, P< 0.01). The results of the above indicators were statistically significant, indicating that Tai Chi was better than control group.ConclusionsAt present, the methodological quality of relevant systematic reviews of Tai Chi for preventing falls in the elderly was relatively low and the quality of the evidence was not good, so it can’t be proved that Tai Chi can effectively prevent falls in the elderly, which needs to be further studied at a high level.
ObjectiveTo compare the impact of early enteral nutrition (EN) and parenteral nutrition (PN) on the postoperative efficacy of esophageal cancer through meta-analysis of relevant randomized controlled trial (RCT).MethodsPubMed, Medline, EMbase, The Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, China Biology Medicine disc (CBMdisc) were searched by computer from inception to April 2018 to identify potential RCT which assessed clinical efficacy between EN and PN for postoperative patients with esophageal cancer. According to the inclusion and exclusion criteria, two researchers independently screened and evaluated literature. Meta-analysis was performed by RevMan 5.3 software.ResultsA total of 30 RCT studies were selected, including 3 969 patients. Meta-analysis results showed that: there was a significant difference between EN and PN in postoperative anastomotic fistulas (I2=0%, OR=0.67, 95%CI 0.45-0.99, P=0.04), postoperative pulmonary infections (I2=0%, OR=0.42, 95%CI 0.32-0.55, P<0.000 1), postoperative albumin levels (I2=38%, MD=0.78, 95%CI 0.51-1.06, P<0.000 01),time of first anal exhaust after operation (I2=0%, MD=–23.16, 95%CI –25.16-21.16, P<0.000 01) and postoperative incision infection (I2=0%, RR=0.36, 95%CI 0.21-0.64, P=0.000 5).ConclusionCompared with PN, early EN can significantly reduce the incidence of major postoperative complications and shorten the time of first anal exhaust after surgery. In addition, EN is superior to PN in improving nutritional status, increasing weight and reducing costs and side effects.
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 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 of systematic reviews of the efficacy and safety of antimicrobials in the prevention of postpartum infection after vaginal delivery, and to provide evidence for the rational use of antimicrobials. MethodsThe CNKI, WanFang Data, VIP, PubMed, Embase, and Cochrane Library databases were searched to collect systematic reviews/meta-analyses on antibiotic prophylaxis for transvaginal delivery from inception to June 25, 2023. The data of the included systematic reviews were extracted by 2 investigators independently, and the methodological quality, risk of bias, and report quality were evaluated by AMSTAR 2.0 scale, ROBIS tool, and PRISMA, respectively. And a pool of outcomes for assessing the effectiveness of antimicrobials in prevention of postpartum infection after transvaginal delivery was developed. ResultsA total of 7 systematic reviews were included. And the AMSTAR 2.0 indicated that most studies (5/7) were from very low quality to low quality. The ROBIS tool showed 3 studies with low risk of bias, 3 with high risk of bias, and 1 with unclear risk of bias. The results of the PRISMA statement showed that the included system evaluation reports were relatively complete. The present evidence showed that prophylactic use of antimicrobials may be beneficial and recommended in women with Ⅲ-Ⅳ perineal fissures, with no significant benefit in women with manual placenta removal, but prophylactic use of antimicrobials was recommended considering their invasive nature, but it was controversial whether antimicrobials should be used in the categories of vaginal assisted delivery, perineal lateralization, and spontaneous delivery (without complications). ConclusionAntimicrobial prophylaxis may not be recommended for all the pregnant women undergoing vaginal delivery to prevent the postpartum infection, but considering the low methodological quality of the included systematic review and the inconsistent outcomes in this field, the conclusion should be further verified by future research with high-quality.
ObjectiveTo overview of systematic reviews (SRs) of Yiqi Fumai (YQFM) injection in the treatment of chronic heart failure (CHF). MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, CNKI, CBM and WanFang Data databases were electronically searched to collect SRs of YQFM injection in the treatment of CHF from January 1, 2007 to October 31, 2022. Two reviewers independently screened literature, extracted data and assessed methodological quality, risk of bias, report quality and evidence quality by using AMSTAR-2, ROBIS scale, PRISMA, and GRADE system. ResultsA total of 7 SRs were included. The evaluation results showed that the quality of all SRs was low, a few SRs were assessed as having a low risk of bias, and all SRs were relatively completely reported. A total of 46 results were extracted from the included SRs, including 3 with moderate quality evidence, 12 with low quality evidence and 31 with very low quality evidence. ConclusionYQFM may be an effective and safe treatment, but current evidence quality is low.
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.
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.