ObjectiveTo evaluate the method quality of systematic reviews/Meta analysis published in nursing journals. MethodsWe retrieved Chinese Biomedical Literature Database, Chinese academic literature online publishing pool and Chinese Scientific Journals Database (the duration was from the beginning to August, 2013). The systematic reviews and Meta analysis published in nursing journals were included, and were evaluated by 10 items in OQAQ (Oxman-Guyatt Overview Quality Assessment Questionnaire). ResultsA total of 74 literatures were included in the analysis, including 17 systematic reviews and 57 Meta-analyses. It showed that the mean OQAQ score was 2.92±1.63. About 4.1%, 8.1%, 31.1%, 43.2%, 29.7%, 55.4%, 16.2%, 37.8%, and 60.8% studies stated literature research methods used to find evidence; had reasonably comprehensive search; avoided bias in the selection of studies by duplicate screening; reported the criteria used for assessing the validity of the included studies; concluded the findings by the data or analysis; provided a list of studies; assessed using appropriate criteria; reported the methods used to synthesis the findings; and combined the findings of the included studies appropriately. ConclusionThe systematic reviews/Meta analysis of the overall quality in nursing field is low. The search strategy, inclusion and exclusion criteria, quality assessment and data analysis is particularly prominent, researchers should conduct rigorous methodological training.
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.
ObjectiveTo systematically evaluate the effects of closed drainage and simply closed drainage combined with pleurodesis in the treatment spontaneous pneumothorax. MethodsWe searched PubMed, Web of Science, The Cochrane Library, CBM, WanFang Data and CNKI from their inception to December 2nd, 2014, to collect randomized controlled trials (RCTs) of simple closed drainage versus closed drainage combined with pleurodesis in the treatment of spontaneous pneumothorax. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the risk of bias of included studies. Then, RevMan 5.3 software was used for meta-analysis. ResultsA total of 5 RCTs including 499 patients were included. The results of meta-analysis showed that:Compared with the simple closed drainage, the closed drainage combined with pleurodesis was superior in the effective rate of recurrence spontaneous pneumothorax (OR=6.85, 95%CI 3.26 to 14.39, P<0.000 01) and the recurrence rate of primary spontaneous pneumothorax (OR=0.32, 95%CI 0.18 to 0.57, P<0.001). But there were no statistical differences in both groups in the effective rate of primary spontaneous pneumothorax (OR=1.49, 95%CI 0.71 to 3.14, P=0.29), the hospital stays of primary spontaneous pneumothorax (SMD=0.08, 95%CI -0.16 to 0.31, P=0.52), the hospital stays of recurrence spontaneous pneumothorax (SMD=-1.67, 95%CI -3.96 to 0.61, P=0.15), and the duration of drainage of primary spontaneous pneumothorax (SMD=-0.11, 95%CI 0.79 to 0.58, P=0.76). ConclusionCurrent evidence suggests that closed drainage combined with pleurodesis could improve the effective rate of recurrence spontaneous pneumothorax and decrease the recurrence rate of primary spontaneous pneumothorax. Due to limited quantity and quality of included studies, the above conclusion should be validated by more high quality studies.
Objective To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract. Method Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration. Results A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(Plt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (Plt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, Plt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, Plt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference. Conclusion The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.
Evidence-informed decision making is one of the most common, objective and important health policy research methods used by policy makers. Its purpose is to promote the application and dissemination of research knowledge on health policy and systems to change traditional and subjective models of health policy making in order to improve national and regional health systems. Three elements will influence the effectiveness of health policy making:research evidence, available health resources and the value of policy formulation. This paper introduces some pragmatic evidence-based approaches, especially systematic reviews, priority setting and a combined approach matrix (CAM). Systematic reviews have a b impact on the decision process for policy makers. We hope that the application and development of evidence-informed methods will increase in China’s health policy research.
Objective To review systematically the effectiveness and safety of astragaulus membranaceus in the treatment of diabetic nephropathy (DN). Methods A Cochrane systematic review of all relevant randomized or quasi-randomized controlled trials of astragaulus membranaceus for diabetic nephropathy was performed. Clinical trials were searched for in the Cochrane Central Refister of Controlled Trials, MEDLINE, EMBASE, the Chinese Biological Medicine Database, and the Chinese Science and Technology Journal Full-text Database as well as in the references lists of all included trials. Two reviewers works independently to select studies, assess methodological quality and extract data. The following indexes were included to assess the clinical effectiveness and safety of astragaulus membranaceus: 24-hour urinary albumin excretion rate (UAER), 24-hour urinary protein, clearance of creatinine (Ccr), serum creatinine (Scr), blood urea nitrogen (BUN), fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), triglyceride (TG), total cholesterol (TC), and serious adverse events. Results Thirty-four clinical trials involving 2 356 patients met the inclusion criteria, but most of these trials were small and of low quality . A “funnel plot” showed asymmetry, which indicated possible publication bias, such that trials with negativeresults might not have been published. Meta-analyses showed that astragaulus membranaceus had some effects on the decrease of the 24-hour UAER, 24-hour urinary protein, Scr and BUN, and also on the improvement of Ccr. Therefore, astragaulus membranaceus, to a certain extent, was found to be effective in improving renal functions of DN patients. However, astragaulus membranaceus might have similar effects in decreasing the 24-hour UAER and Scr compared with angiotensin-converting enzyme inhibitor and angiotensin receptor blockers. Compared with other Chinese medicines, astragaulus membranaceus was more effective in decreasing the 24-hour urinary protein. No serious adverse events were observed during the treatment period. Conclusion Astragaulus membranaceus has some effect and is relatively safe in treating patients with diabetic nephropathy. However, the present evidence was not enough to support the recommendation of astragaulus membranaceus as a routine drug in the clinical management of DN.Since most included trials are small and of low quality, high-quality, large-sample, multi-centre, randomized, double-blind and placebo-controlled trials of astragaulus membranaceus for DN are needed.
Objective To make an individualized treatment plan for newly diagnosed irritable bowel syndrome by means of evidence-based medicine. Methods After clinical problems were put forward, systematic reviews and randomized controlled trials were collected from The Cochrane Library (Issue 3, 2008) and PubMed (1990 to 2008). Treatment protocol was produced by combining the evidence and the values of the patient. Results A total of 114 RCTs and 21 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data to control symptoms and improve the quality of life for the patient. After a sixteen-month follow-up, the plan proved to be optimal. Conclusion The treatment efficacy in diagnosed irritable bowel syndrome has been improved by determining an individualized treatment plan according to evidence-based methods.
The AMSTAR 2, a critical appraisal tool, was developed for assessing systematic reviews which included randomized or non-randomized studies of healthcare interventions, or both. It was recently published in BMJ. This paper introduces AMSTAR 2 and interprets its usage by a published systematic review.
Systematic reviews of the effects of healthcare interventions are now quite common. There are currently more than 2 600 full Cochrane reviews in The Cochrane Library, with protocols published for 1 600 more. There are also thousands of systematic reviews published in other journals. However, the science of systematic reviewing is still relatively young. Most of the reviews available today rely on randomised trials, but there are also some reviews of non-randomised trials and of diagnostic test accuracy and these may become more common in the next few years. In this essay, I discuss some of the challenges of doing these newer types of systematic review, and show how experience gained in the last few decades of systematic reviews of randomised trials might help to meet these challenges.
Objective To systematically review the predictive model of stroke-related pneumonia risk. Methods The CNKI, WanFang Data, CBM, PubMed, Web of Science, Embase, MEDLINE and Cochrane Library databases were electronically searched to collect studies on risk prediction models for stroke-associated pneumonia from inception to February 15, 2023. Two researchers independently screened the literature and extracted data. The risk of bias and applicability of the models were assessed using PROBAST. Results A total of 18 studies and 27 SAP risk prediction models were included. The AUC values for inclusion in the model ranged from 0.67 to 0.96, and the number of candidate predictors ranged from 4 to 25, with the most common predictors being age, NIHSS score, dysphagia, mRS score, and impaired consciousness (GCS score). Conclusion The overall predictive performance of SAP risk prediction models is good, but their predictive performance cannot be directly compared because of the differences in study type, study population, and SAP diagnostic criteria. Moreover, 72.3% of the models are not externally validated, and most of the studies have a high risk of bias.