On the criteria used for assessing the risk of bias in randomized trials included in systematic reviews and meta-analyses addressing adverse effects

2015 ◽  
Vol 30 (3) ◽  
pp. 249-250 ◽  
Author(s):  
Stefanos Bonovas ◽  
Theodore Lytras ◽  
Georgios Nikolopoulos
Keyword(s):  
Adverse Effects ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Risk Of Bias ◽  
Meta Analyses

scholarly journals Electroconvulsive therapy in the continuation and maintenance treatment of depression: Systematic review and meta-analyses

2017 ◽  
Vol 52 (5) ◽  
pp. 415-424 ◽  
Author(s):  
Alby Elias ◽  
Vivek H Phutane ◽  
Sandy Clarke ◽  
Joan Prudic
Keyword(s):  
Confidence Interval ◽  
Electroconvulsive Therapy ◽  
Risk Ratio ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Risk Of Bias ◽  
Meta Analyses ◽  
Depressive Episodes

Objective: Acute course of electroconvulsive therapy is effective in inducing remission from depression, but recurrence rate is unacceptably high following termination of electroconvulsive therapy despite continued pharmacotherapy. Continuation electroconvulsive therapy and maintenance electroconvulsive therapy have been studied for their efficacy in preventing relapse and recurrence of depression. The purpose of this meta-analysis was to examine the efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy in preventing relapse and recurrence of depression in comparison to antidepressant pharmacotherapy alone. Methods: We searched MEDLINE, Embase, PsycINFO, clinicaltrials.gov and Cochrane register of controlled trials from the database inception to December 2016 without restriction on language or publication status for randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. Two independent Cochrane reviewers extracted the data in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. The risk of bias was assessed using four domains of the Cochrane Collaboration Risk of Bias Tool. Outcomes were pooled using random effect model. The primary outcome was relapse or recurrence of depression. Results: Five studies involving 436 patients were included in the meta-analysis. Analysis of the pooled data showed that continuation electroconvulsive therapy and maintenance electroconvulsive therapy, both with pharmacotherapy, were associated with significantly fewer relapses and recurrences than pharmacotherapy alone at 6 months and 1 year after a successful acute course of electroconvulsive therapy (risk ratio = 0.64, 95% confidence interval = [0.41, 0.98], p = 0.04, risk ratio = 0.46, 95% confidence interval = [0.21, 0.98], p = 0.05, respectively). There was insufficient data to perform a meta-analysis of stand-alone continuation electroconvulsive therapy or maintenance electroconvulsive therapy beyond 1 year. Conclusion: There are only a few randomized trials of continuation electroconvulsive therapy and maintenance electroconvulsive therapy. The preliminary and limited evidence suggests the modest efficacy of continuation electroconvulsive therapy and maintenance electroconvulsive therapy with concomitant pharmacotherapy in preventing relapse and recurrence of depressive episodes for 1 year after the remission of index episode with the acute course of electroconvulsive therapy.

scholarly journals The development of a new generic risk-of-bias measure for systematic reviews of surveys

Methodology ◽  
2020 ◽  
Vol 16 (4) ◽  
pp. 278-298
Author(s):  
Gabriel Nudelman ◽  
Kathleen Otto
Keyword(s):  
Pilot Study ◽  
Systematic Reviews ◽  
Convergent Validity ◽  
Meta Analysis ◽  
Weighted Kappa ◽  
Risk Of Bias ◽  
Interrater Agreement ◽  
Bias Measure ◽  
Meta Analyses ◽  
Initial List

It is important to evaluate risk of bias of the primary studies included in systematic reviews and meta-analyses. Since tools pertinent to surveys are scarce, the goal of the current research was to develop a measure to address this need. In Study 1, an initial list of 10 relevant topics was compiled from previous measures. In Study 2, the list was refined into an eight-item risk-of-bias measure via discussion and a pilot study. In Study 3, experienced researchers used the measure to asses 70 studies, demonstrating high interrater agreement (weighted Kappa = .82). Inexperienced raters also utilized the measure to code 26 different studies included in a prior meta-analysis, which resulted in adequate interrater agreement (weighted Kappa = .64) and excellent convergent validity (r = .66). Thus, the new measure, designed to be accessible and flexible, can increase standardization of risk-of-bias evaluations and contribute to the interpretation of systematic reviews and meta-analytic findings.

scholarly journals Processed Meat Consumption and the Risk of Cancer: A Critical Evaluation of the Constraints of Current Evidence from Epidemiological Studies

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3601
Author(s):  
Mina Nicole Händel ◽  
Jeanett Friis Rohde ◽  
Ramune Jacobsen ◽  
Berit Lilienthal Heitmann
Keyword(s):  
General Population ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Meat Products ◽  
Meat Consumption ◽  
Risk Of Bias ◽  
Processed Meat ◽  
Meta Analyses ◽  
Risk Of Cancer ◽  
Processed Meat Consumption

Based on a large volume of observational scientific studies and many summary papers, a high consumption of meat and processed meat products has been suggested to have a harmful effect on human health. These results have led guideline panels worldwide to recommend to the general population a reduced consumption of processed meat and meat products, with the overarching aim of lowering disease risk, especially of cancer. We revisited and updated the evidence base, evaluating the methodological quality and the certainty of estimates in the published systematic reviews and meta-analyses that examined the association between processed meat consumption and the risk of cancer at different sites across the body, as well as the overall risk of cancer mortality. We further explored if discrepancies in study designs and risks of bias could explain the heterogeneity observed in meta-analyses. In summary, there are severe methodological limitations to the majority of the previously published systematic reviews and meta-analyses that examined the consumption of processed meat and the risk of cancer. Many lacked the proper assessment of the methodological quality of the primary studies they included, or the literature searches did not fulfill the methodological standards needed in order to be systematic and transparent. The primary studies included in the reviews had a potential risk for the misclassification of exposure, a serious risk of bias due to confounding, a moderate to serious risk of bias due to missing data, and/or a moderate to serious risk of selection of the reported results. All these factors may have potentially led to the overestimation of the risk related to processed meat intake across all cancer outcomes. Thus, with the aim of lowering the risk of cancer, the recommendation to reduce the consumption of processed meat and meat products in the general population seems to be based on evidence that is not methodologically strong.

Auriculoterapia para o tratamento da ansiedade em estudantes universitários: revisão sistemática

2021 ◽  
Author(s):  
◽  
Lara dos Santos Silva
Keyword(s):  
Clinical Trials ◽  
Systematic Reviews ◽  
Ad Hoc ◽  
Cochrane Collaboration ◽  
Risk Of Bias ◽  
Meta Analyses ◽  
Tecnología Educativa

A ansiedade está entre os transtornos mentais de maior prevalência na população mundial, sendo a segunda causa de incapacidade mental no mundo. Dentre a população suscetível à ansiedade, destacam-se os estudantes universitários, em decorrência das situações vivenciadas no âmbito acadêmico. Os tratamentos da ansiedade podem estar pautados em recursos medicamentosos e não medicamentosos. Dentre os não medicamentosos, destacam-se as Práticas Integrativas e Complementares em Saúde e, dentre estas, a auriculoterapia. O objetivo geral deste estudo foi s intetizar as evidências disponíveis na literatura científica sobre o uso da auriculoterapia no tratamento da ansiedade em estudantes universitários. Trata-se de uma revisão sistemática da literatura, realizada em 16 bases de dados, com início em 20 de janeiro e revisão até 27 de março de 2021. Todo o processo de busca e seleção dos artigos foi feito de modo independente e pareado, e, quando necessário, um terceiro pesquisador com experiência na temática auxiliava como ad hoc na resolução dos conflitos. O relato da revisão pautou-se na diretriz Preferred Reporting Items for Systematic Reviews and Meta-Analyses, e o protocolo da revisão foi cadastrado na plataforma International Prospective Register of Systematic Reviews (registro No CRD42020205968). Utilizou-se as diretrizes Standards for Reporting Interventions in Clinical Trials of Acupuncture, Cochrane Collaboration Risk of Bias Tool, e escala de JADAD para avaliação dos artigos. A amostra final foi composta por cinco artigos. A análise dos mesmos mostrou que a auriculoterapia contribuiu para tratar a ansiedade de estudantes universitários. O uso desta intervenção deve ser considerado pelas instituições formadoras para promoção da saúde mental nesta população, e pode contribuir para a melhora do desempenho acadêmico, redução das taxas de evasão, e melhora da qualidade de vida aos universitários. O estudo também possibilitou a elaboração de uma tecnologia educativa no formato de cartilha, com o objetivo de esclarecer aos estudantes universitários sobre a ansiedade como um problema de saúde relevante na população, bem como apresentar a auriculoterapia como uma possibilidade terapêutica. Pretende-se que, em momento oportuno, a mesma seja divulgada em formato eletrônico para toda a comunidade acadêmica. Palavras-chave: Auriculoterapia. Terapia auricular. Ansiedade. Estudantes.

scholarly journals When poorly conducted systematic reviews and meta-analyses can mislead: a critical appraisal and update of systematic reviews and meta-analyses examining the effects of probiotics in the treatment of functional constipation in children

2019 ◽  
Vol 110 (1) ◽  
pp. 177-195 ◽  
Author(s):  
Rebecca G Harris ◽  
Elizabeth P Neale ◽  
Isabel Ferreira
Keyword(s):  
Systematic Reviews ◽  
Evidence Synthesis ◽  
Weighted Mean Difference ◽  
Treatment Success ◽  
Functional Constipation ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Success Rates ◽  
Defecation Frequency ◽  
Meta Analyses

ABSTRACT Background Recent systematic reviews and meta-analyses on the efficacy of probiotics in the treatment of functional constipation in children have yielded conflicting results. Objectives The aim of this study was to critically review and update the evidence in this field by mapping all the steps involved against those reported in previous reviews, in an attempt to understand the nature of their conflicting results. Methods Four literature databases, trial registries, and citations were searched through December 1, 2018. We included randomized controlled trials (RCTs) that assessed the effects of probiotics compared with placebo or treatment as usual on defecation frequency [bowel movements (BMs)/wk] or treatment success rates in children with functional constipation. Independent reviewers extracted the data and assessed risk of bias in each RCT. Data were pooled with (inverse variance) random-effects models. Results We identified 17 RCTs, of which 14 and 11 provided sufficient data to enable meta-analysis of the effects of probiotics compared with control on defecation frequency (n = 965) or treatment success (n = 835), respectively. When compared to (any) control intervention, probiotics did not significantly increase defecation frequency [weighted mean difference (WMD): 0.28 BMs/wk; 95% CI: −0.12, 0.69; P = 0.165] but were more efficacious in achieving treatment success (RR: 1.24; 95% CI: 1.03, 1.50; P = 0.024). These effects did not differ by type of control (i.e., active or inactive) intervention. However, in analyses confined to the RCTs that were free of high risk of bias (only 5), probiotics did not confer any beneficial effects on defecation frequency (WMD: −0.55 BMs/wk; 95% CI: −1.37, 0.26; P = 0.185) and achievement of treatment success (RR: 1.01; 95% CI: 0.90, 1.13; P = 0.873), compared with control interventions. Conclusions The current evidence thus does not support the use of probiotics as a single or coadjuvant therapy for treatment of functional constipation in children and refutes recently published reviews reporting favorable effects of probiotics. Conflicting findings of previous reviews resulted from methodologic errors, highlighting the susceptibility of evidence synthesis to oversights in study selection, quality assessments, and data extraction and collation. This review was registered at PROSPERO as CRD42019119109.

Is grey literature essential for a better control of publication bias in psychiatry? An example from three meta-analyses of schizophrenia

2005 ◽  
Vol 20 (8) ◽  
pp. 550-553 ◽  
Author(s):  
José Luis R. Martin ◽  
Víctor Pérez ◽  
Montse Sacristán ◽  
Enric Álvarez
Keyword(s):  
Publication Bias ◽  
Systematic Reviews ◽  
Meta Analysis ◽  
Grey Literature ◽  
Risk Of Bias ◽  
Medical Databases ◽  
Study Results ◽  
Heterogeneous Nature ◽  
Meta Analyses ◽  
Literature Material

AbstractSystematic reviews in mental health have become useful tools for health professionals in view of the massive amount and heterogeneous nature of biomedical information available today. In order to determine the risk of bias in the studies evaluated and to avoid bias in generalizing conclusions from the reviews it is therefore important to use a very strict methodology in systematic reviews. One bias which may affect the generalization of results is publication bias, which is determined by the nature and direction of the study results. To control or minimize this type of bias, the authors of systematic reviews undertake comprehensive searches of medical databases and expand on the findings, often undertaking searches of grey literature (material which is not formally published). This paper attempts to show the consequences (and risk) of generalizing the implications of grey literature in the control of publication bias, as was proposed in a recent systematic work. By repeating the analyses for the same outcome from three different systematic reviews that included both published and grey literature our results showed that confusion between grey literature and publication bias may affect the results of a concrete meta-analysis.

Pharmacological Interventions for Borderline Personality Disorder

2017 ◽  
Author(s):  
Kenneth R. Silk
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Systematic Reviews ◽  
Patient Population ◽  
Randomized Trials ◽  
Borderline Personality ◽  
Pharmacological Interventions ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Meta Analyses

Although no medication is indicated to specifically treat symptoms of borderline personality disorder (BPD), medications are used frequently in the treatment of patients with BPD. This chapter reviews a number of reasons why medications are frequently prescribed in this patient population, then goes on to discuss eight systematic reviews or meta-analyses of 23 double-blind placebo-controlled randomized trials of the psychopharmacologic treatment of patients with BPD. The author attempts to make some sense of these reviews, which at times come to different conclusions despite examining essentially the same dataset. The chapter also addresses how to proceed with and manage the psychopharmacologic treatment of patients with BPD.

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