ObjectiveTo investigate the status of research and development methods of Cochrane overviews. MethodsThe Cochrane Library and PubMed were searched up to March 2014 to identify Cochrane overviews. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and assessed and analyzed search strategy, quality assessment method, data analysis, and study results. ResultsA total of 18 Cochrane overviews were included. Among them, 4 (22.2%) overviews included formal statistical indirect comparison; 8 (44.4%) included only results from direct comparison; 6 (33.4%) only systematically analyzed current studies without data pooling; 12 (66.7%) only searched The Cochrane Library, while 6 (33.3%) expanded search to other databases; 14 (77.8%) applied the AMSTAR tool to assess methodological quality of included literature; 12 (66.7%) applied the GRADE system to assess the quality of evidence; and 9 (50%) yielded new outcomes. ConclusionCurrently, the development and reporting standards of Cochrane overviews are still immature. Investigators should choose proper methods based on research objectives when developing Cochrane overviews.
AMSTAR (Assessment of Multiple Systematic Reviews) is currently developed as a measurement tool with extensive application to assess the methodological quality of systematic review/meta-analysis. It has good reliability, validity, and responsibility, and has been widely applied. This paper introduces AMSTAR to researchers and users in China, in view of development procedure, assessment items, and application status.
ObjectiveTo investigate the reporting and methodological quality of systematic reviews/ meta-analyses conducted by hospital pharmacists in China, so as to improve the quality of systematic reviews/ meta-analyses in this field. MethodsThe literatures were retrieved from CNKI, WanFang Data, VIP, CBM, CMCI, PubMed, EMbase, The Cochrane Library from the establishment date to March 17th, 2016. According to the inclusive and exclusive criteria, authors independently screened and extracted the published information. Reporting and methodological quality of included reviews were evaluated by PRIMSA statements and AMSTAR checklists. Data analysis was conducted by using Excel 2013 software and SPSS 20.0 software. ResultsOne thousand and eighteen systematic reviews/ meta-analyses were included, including 871 Chinese literatures and 147 English literatures. The average score of PRIMSA was 18.41±2.84, and the average score of AMSTAR was 7.38±1.28. The main problems of PRIMSA were structured summary, objectives, protocol and registration, additional analyses and funding. The main problems of AMSTAR were priori design, status of publication and list of studies (included and excluded). Univariate analysis showed that some factors could improve the quality of methodology and reporting, including studies in English (P<0.000 1), published after checklists' (P<0.000 1), hospital in higher-level (P<0.000 1), illuminating the funding or interest conflict (P<0.000 1). Pearson analysis indicated that linear correlation were detected between PRISMA scores and AMSTAR scores (P<0.000 1), as well as citations and AMSTAR scores (P=0.045). ConclusionEvidenced-based pharmacy in hospital has developed rapidly, the quality of methodology and reporting have increaseed year by year, but further improvement should be considered in different aspects. The methods to evaluate the clinical application of these systematic reviews/ meta-analyses should be developed in the future.
Objective To assess the methodological quality of systematic reviews/ meta-analysis of burden of illness, analyses the factors affecting it, so as to provide a reference basis for improving the methodological quality of related studies. Methods Systematic reviews/ meta-analysis of burden of illness were identified in PubMed, searching from its inception to 12 October 2024. Systematic reviews/ meta-analysis of burden of illness was included, the methodological quality of the included literature was evaluated using AMSTAR-2, and data were extracted using Excel 2021. Results A total of 308 systematic reviews/ meta-analysis were included, with a fluctuating upward trend in the number of publications from 2006 to 2024; of these, a total of 12 were rated as low quality. According to the AMSTAR-2 entries, the largest number of documents fully conformed to entry 16 (82.14%), followed by entry 5 (81.49%), and entry 8 (72.73%); one document conformed to entry 10 (0.32%), and relatively few conformed to entry 12 (68.83%), entry 13 (85.39%), and entry 15 (67.53%). ConclusionThe methodological quality of systematic reviews/ meta-analysis of burden of illness needs to be improved, and the main problems include the lack of pre-study protocols, the absence of a list of excluded literature, and the less than adequate explanation of heterogeneity and risk of bias, etc. There is still a need to further improve the methodological quality of the systematic reviews and to promote the long-term development of evidence based medicine.
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.
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/meta-analysis (SR/MA) for the effectiveness of yoga on patients with type 2 diabetes mellitus. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Cochrane Library, Embase, Web of Science, JBI and CINAHL databases were electronically searched to collect SR/MA on the intervention of yoga in diabetes mellitus from inception to November 6th, 2023. Two researchers independently screened the literature and extracted data. AMSTAR was used to evaluate the quality of methodology, and GRADE was used to evaluate the certainty of evidence, and the outcome indicators were statistically analyzed. Results A total of 14 SR/MA were included. The evaluation results of AMSTAR showed that 7 articles were of high quality and 7 articles were of moderate quality. The result of GRADE showed that there were 2 items of high-level evidence, 26 items of intermediate evidence, and the remaining 31 items were low-level or very low-level evidence. The results showed that yoga could significantly reduce fasting blood glucose (FBG) (moderate confidence), glycosylated hemoglobin (HA1C) (moderate confidence) and postprandial blood glucose (PPBG) levels (moderate confidence), and was also superior to other interventions in high-density cholesterol (HDL) (moderate confidence), low-density cholesterol (LDL) (moderate confidence), triglyceride (TG) (moderate confidence), total cholesterol (TC) (moderate confidence), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (moderate confidence), muscle strength (high confidence), cardiorespiratory fitness (moderate confidence) and weight (moderate confidence). Conclusion The existing evidence shows that yoga has a good effect on blood glucose control (moderate confidence) and also has a certain effect on lipid parameters (moderate confidence) and anthropometric indicators (moderate confidence), but the quality and confidence of the current research evidence are low. Future researchers should standardize the research design to provide more high-quality evidence for the prognosis and treatment of type 2 diabetes mellitus.
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 comprehensively evaluate the methodological quality and applicability of the results of systematic reviews on acupuncture treatment for primary depression.MethodsWeb of Science, EMbase, PubMed, The Cochrane Library, CNKI, CBM, WanFang Data and VIP databases were electronically searched to collect systematic reviews/meta-analyses on acupuncture treatment for primary depression from inception to December 5th, 2018. Two researchers independently screened and extracted data by using tools of AMSTAR 2 to evaluate the methodological quality, using ROBIS to assess risk of bias, and using CASP-S.R to evaluate the applicability of the results.ResultsA total of 18 systematic reviews/meta-analyses were included, and all focused on acupuncture intervention, including 2 primary outcome indicators. According to AMSTAR 2 evaluation results, there were 4 high quality studies, 12 medium quality studies and 2 low quality studies; ROBIS results found 10 high bias risk studies, 7 low bias risk studies and 1 unclear; CASP-S.R showed only 4 design studies applicable to local individuals, and there were no studies on the relationship between design benefits, hazards and costs.ConclusionsThe quality of systematic reviews/meta-analyses for acupuncture treatment of primary depression is moderate, however with a certain bias. Most studies may not directly benefit local individuals. All studies have no relationship with cost hazards. It is expected for further reviewers to strictly follow systematic evaluation method to improve research quality and reduce bias, while the applicability of the systematic review to individuals from different regions should be considered as well as the relationship between the benefit and cost hazard. In addition, more valid RCTs are required to provide higher quality evidence and explore correlated and comprehensive mechanism.
ObjectiveTo overview the systematic reviews/meta-analyses (SRs/MAs) of efficacy and safety of dipeptidyl peptidase-4 inhibitors (DPP-4) in treatment of type 2 diabetes mellitus (T2DM).MethodsDatabase including The Cochrane Library, PubMed, EMbase, CBM, WanFang Data and CNKI were searched from inception to December 2016 to collect SRs/MAs of randomized controlled trials (RCTs) of DPP-4 for the treatment of T2DM. Two reviewers independently screened literature, extracted data, and evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool.ResultsTwenty-seven SRs/MAs of DPP-4 for the treatment of T2DM were included in this overview. The average score of AMSTAR was 7.04. The worst score were the item 1 (26 studies didn't provide an ‘a priori’ design), item 4 (10 studies didn't provide whether the status of publication used as an inclusion criterion?), item 10 and item 11 (15 studies didn't assess the likelihood of publication bias and the potential conflicts of interest). The PRISMA score ranged from 17.0 to 24.5. The main problems of reporting were protocol and registration, search, additional analyses and funding.ConclusionThe evidence shows that the reporting and methodological quality of the SRs/MAs of DPP-4 inhibitors for type 2 diabetes are not high.