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 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.
ObjectiveTo re-evaluate the systematic review and meta-analysis (SR/MAs) of the efficacy of robot-assisted pedicle screw placement. MethodsThe CNKI, VIP, WanFang Data, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science databases were electronically searched to collect SR/MAs of robot-assisted pedicle screw placement from inception to April 28, 2023. Two reviewers independently screened literature, extracted data and then assessed the quality of reports, methodological quality, risk of bias, and the strength of evidence quality by using PRISMA, AMSTAR-Ⅱ, ROBIS, and GRADE tool. ResultsA total of 20 SR/MAs were included. The results of the included studies showed that robot-assisted pedicle screw placement was more accurate and had a lower number of complications compared with freehand pedicle screw placement. The quality of reports, methodology, and evidence for pedicle screw placement efficiency in all SR/MAs were low or extremely low, with a high risk of bias. The main reasons included high heterogeneity of included studies, unclear research methods and selection criteria, and missing key reporting processes. ConclusionRobot-assisted pedicle screw placement may have better clinical efficiency than traditional freehand pedicle screw placement. But the quality of relational SR/MAs is low.
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.
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.
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.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews (SRs) on urate-lowering therapy (ULT) for chronic gout. Methods PubMed, EMbase, The Cochrane Library, Epistemonikos, CBM, WanFang Data and CNKI databases were electronically searched to collect published systematic reviews and meta-analyses evaluating urate-lowering drugs in chronic gout from inception to April 8th 2017. Two reviewers independently screened literature, extracted data, assessed the methodological quality of included SRs using the AMSTAR tool, and assessed the quality of the body of evidence for each outcome using the GRADE approach. Results A total of 11 relevant SRs/Mets were included, containing 3 main outcome measures. All these SRs contained allopurinol. Ten SRs contained febuxostat, 3 SRs contained benzbromarone and 1 SR contained probenecid. Ten SRs assessed the risk of bias of included original studies. Eight SRs used the" assessing risk of bias”tool recommended by Cochrane Collaboration for this assessment while 2 used other tools. The assessment results of AMSTAR tool showed: the scores of 4 SRs were ≥9, and the others were ≤8. GRADE results showed: the quality of the evidence of 20 outcomes was low or very low, 10 outcomes was moderate and two outcomes was high. Conclusions Moderate quality evidence shows that febuxostat is beneficial in achieving target serum uric acid levels when comparing to allopurinol, and high quality evidence shows the incidence of gout flares is not significantly different between the two groups. High quality evidence also shows that the safety of febuxostat is better than allopurinol. Evidence of SRs is still insufficient to support the effectiveness and safety of other urate-lowering drugs. It is expected that more scientific and rigorous researches will be performed in the future, for which more high quality evidence will be produced to fill relevant gaps.
ObjectiveTo summarize and evaluate the quality of methodology, report and evidence of the systematic reviews and meta-analyses (SRs/MAs) of acupuncture and moxibustion interventions for Parkinson's disease. MethodsEight databases including CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Cochrane Library and Web of Science were searched from inception to May 1, 2023. The quality of methodology, report and evidence involved in these studies were evaluated by AMSTAR 2, PRISMA and GRADE tool. ResultsA total of 28 SRs/MAs were included, and the findings of included studies showed that acupuncture and moxibustion had a clinical advantage for Parkinson's disease. The methodological quality of all studies was extremely low. Thirteen reports were relatively complete, 14 reports had certain flaws, and 1 report had relatively serious flaws. And of the 126 reports for seven outcomes, 1 was graded as high, 12 as moderate, 57 as low, and 56 as critically low. ConclusionThe current evidence shows that acupuncture and moxibustion have a certain clinical effect for Parkinson's disease, but the methodological quality and evidence quality of related SRs/MAs are low, and the standardization still needs to be improved. The efficacy of acupuncture and moxibustion in Parkinson's disease still needs to be verified by high-quality clinical studies in the future.
ObjectiveTo systematically summarize and evaluate the existing evidence of Qishen Yiqi dropping pill (QSYQ) in the treatment of chronic heart failure (CHF), and to evaluate its quality. MethodsThe PubMed, Cochrane Library, EMbase, Web of Science, CNKI, CBM, WanFang Data databases were electronically searched to collect systematic reviews/meta-analyses(SRs/MAs) related to objectives from inception to December 31, 2022. Two researchers independently screened the literature and extracted data, and assessed the methodological quality, risk of bias, reporting quality, and quality of evidence of included SRs/MAs by using Assessment of Multiple Systematic Reviews 2 (AMSTAR-2), the Risk of Bias in Systematic(ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analysis(PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. ResultsThis overview included 17 SRs/MAs. The methodological quality, reporting quality, risk of bias, and quality of evidence for outcome measures of SRs/MAs were all unsatisfactory. All SRs/MAs were of low quality according to the results of the AMSTAR-2 assessment. And only a small number of SRs/MAs were assessed as low risk of bias based on the results of the ROBIS assessment. The evaluation results of the PRISMA checklist showed that the report quality of the 24 studies included was relatively complete. According to the GRADE system evaluation results, 94% of the 84 outcome indicators were low-quality and very low-quality evidence. Limitations were the main factors leading to their degradation, followed by publication bias, inconsistency, imprecision and indirectness. ConclusionAt present, QSYQ has good clinical efficacy in the treatment of CHF, but the standardization and scientificity of clinical research and secondary research reports are insufficient, resulting in low quality of clinical recommendations evidence. In the future, it is necessary to further standardize and improve the quality of clinical and secondary research.
Objectives To evaluate the methodological bias and the reliability of the conclusions of systematic reviews on acupuncture for polycystic ovary syndrome. Methods We comprehensively searched PubMed, EMbase, The Cochrane Library, CBM, CNKI and WanFang Data to collect systematic reviews on acupuncture for polycystic ovary syndrome from the establishment time of databases to January 5th, 2018. The AMSTAR tool was applied for methodological quality assessment of included studies and the GRADE system was applied for evidence quality assessment of included outcomes of systematic reviews. Results A total of 11 systematic reviews were included. The results of assessment using AMSTAR showed that, among the 11 items, most problems occurred in Item 5 " Were there any lists of research articles included and excluded”, followed by Item 1" Was an‘a prior’design provided?”and Item 11" Were potential conflict of interest included?”. GRADE grading results showed that quality of evidence for the outcome measure were" low”or" very low”. Conclusions Current acupuncture treatment of polycystic ovary syndrome has a certain effect, however, the quality of evidence is low. Thus, physicians should apply the evidence to make decision on acupuncture for polycystic ovary syndrome with caution in clinical practice and consider the actual situation, combined with the patient’s value preferences and economic factors.
