scholarly journals Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM): Introduction of a Strength-of-evidence Approach Based on a Methodological Systematic Review (P13-023-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
David Katz ◽  
Micaela Karlsen ◽  
Mei Chung ◽  
Marissa Shams-White ◽  
Lawrence Green ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Epigenetic Modification ◽  
Exercise Stress ◽  
Narrative Form ◽  
Lifestyle Medicine ◽  
Strength Of Evidence ◽  
Levels Of Evidence ◽  
Assessment Of Evidence ◽  
Meta Analyses ◽  
Lifetime Effects

Abstract Objectives To characterize strength of evidence (SOE) tools in recent use, identify their application to lifestyle medicine, and to assess implications of the findings. Methods The search strategy was created in PubMed and modified as needed for four additional databases: Embase, AnthropologyPlus, PsycINFO, and Ageline. Systematic reviews and meta-analyses were included if they used a specified SOE tool. There were seven interventions or exposures of interest: diet, exercise, stress, social relationships/support, addiction(s), sleep, and genetic-based factors with potential for epigenetic modification. Data was collected for each SOE tool and summarized in narrative form with regard to the conditions necessary for assigning the highest SOE grading and treatment of prospective cohort studies within each SOE rating framework was qualitatively summarized. The expert panel convened to discuss the findings and their implication for assessing evidence in the domain of lifestyle medicine. Results A total of 15 unique tools were identified. All tools rated SOE using three to five levels of evidence, with the exception of one that uses two levels. Ten were tools developed and used by governmental agencies or other equivalent professional bodies and were applicable in a variety of settings. Five require consistent results from RCTs of high quality to award the highest rating of evidence. Except for the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence, specific mention of cohort studies was made only to note their secondary contribution to overall SOE as compared to RCTs, unless RCTs were methodologically flawed. A new construct, Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM), was developed to evaluate SOE for the lifetime effects of health behaviors. Conclusions The best metric for SOE varies with research questions and the methods required to answer them. Assessment of evidence relevant to lifestyle medicine requires a potential adaptation of SOE approaches when outcomes and/or exposures obviate exclusive or preferential reliance on RCTs. Funding Sources Supported by the American College of Lifestyle Medicine, with additional funding from the Centers for Disease Control, grant 5U48DP005023–04. Supporting Tables, Images and/or Graphs

scholarly journals Difference in surgical outcomes of rectal cancer by study design: meta-analyses of randomized clinical trials, case-matched studies, and cohort studies

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
N Hoshino ◽  
T Sakamoto ◽  
K Hida ◽  
Y Takahashi ◽  
H Okada ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Robotic Surgery ◽  
Cohort Studies ◽  
Anastomotic Leakage ◽  
Study Design ◽  
Randomized Clinical Trials ◽  
Postoperative Mortality ◽  
Resection Margins ◽  
Meta Analyses

Abstract Background RCTs are considered the standard in surgical research, whereas case-matched studies and propensity score matching studies are conducted as an alternative option. Both study designs have been used to investigate the potential superiority of robotic surgery over laparoscopic surgery for rectal cancer. However, no conclusion has been reached regarding whether there are differences in findings according to study design. This study aimed to examine similarities and differences in findings relating to robotic surgery for rectal cancer by study design. Methods A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane CENTRAL to identify RCTs, case-matched studies, and cohort studies that compared robotic versus laparoscopic surgery for rectal cancer. Primary outcomes were incidence of postoperative overall complications, incidence of anastomotic leakage, and postoperative mortality. Meta-analyses were performed for each study design using a random-effects model. Results Fifty-nine articles were identified and reviewed. No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. With respect to the incidence of postoperative overall complications and duration of hospital stay, the superiority of robotic surgery was most evident in cohort studies (risk ratio (RR) 0.83, 95 per cent c.i. 0.74 to 0.92, P < 0.001; mean difference (MD) –1.11 (95 per cent c.i. –1.86 to –0.36) days, P = 0.004; respectively), and least evident in RCTs (RR 1.12, 0.91 to 1.38, P = 0.27; MD –0.28 (–1.44 to 0.88) days, P = 0.64; respectively). Conclusion Results of case-matched studies were often similar to those of RCTs in terms of outcomes of robotic surgery for rectal cancer. However, case-matched studies occasionally overestimated the effects of interventions compared with RCTs.

scholarly journals Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment

2021 ◽  
Vol 7 (1) ◽  
pp. e000920
Author(s):  
Dimitris Challoumas ◽  
Neal L Millar
Keyword(s):  
Systematic Reviews ◽  
Assessment Tool ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Mean Difference ◽  
Strength Of Evidence ◽  
The Mean ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cochrane Collaboration

ObjectiveTo critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.Data sourcesMedline from inception to June 2020.Study eligibilityAll SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.Data extraction and synthesisIncluded SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.ResultsA total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.ConclusionsIn light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

scholarly journals Harms of Antipsychotics in Children and Young Adults: A Systematic Review Update

2018 ◽  
Vol 63 (10) ◽  
pp. 661-678 ◽  
Author(s):  
Jennifer Pillay ◽  
Khrista Boylan ◽  
Amanda Newton ◽  
Lisa Hartling ◽  
Ben Vandermeer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Young Adults ◽  
Weight Gain ◽  
Meta Analysis ◽  
Extrapyramidal Symptoms ◽  
Short Term ◽  
Strength Of Evidence ◽  
Cholesterol Levels ◽  
Children And Young Adults ◽  
Meta Analyses

Objective: To update and extend our previous systematic review on first- (FGAs) and second-generation antipsychotics (SGAs) for treatment of psychiatric and behavioral conditions in children, adolescents, and young adults (aged ≤24 years). This article focuses on the evidence for harms. Method: We searched (to April 2016) 8 databases, gray literature, trial registries, Food and Drug Administration reports, and reference lists. Two reviewers conducted study screening and selection independently, with consensus for selection. One reviewer extracted and another verified all data; 2 reviewers independently assessed risk of bias. We conducted meta-analyses when appropriate and network meta-analysis across conditions for changes in body composition. Two reviewers reached consensus for ratings on the strength of evidence for prespecified outcomes. Results: A total of 135 studies (95 trials and 40 observational) were included, and 126 reported on harms. FGAs caused slightly less weight gain and more extrapyramidal symptoms than SGAs. SGAs as a class caused adverse effects, including weight gain, high triglyceride levels, extrapyramidal symptoms, sedation, and somnolence. They appeared to increase the risk for high cholesterol levels and type 2 diabetes. Many outcomes for individual drug comparisons were of low or insufficient strength of evidence. Olanzapine caused more short-term gains in weight and body mass index than several other SGAs. The dose of SGAs may not make a difference over the short term for some outcomes. Conclusions: Clinicians need to weigh carefully the benefit-to-harm ratio when using antipsychotics, especially when treatment alternatives exist. More evidence is needed on the comparative harms between antipsychotics over the longer term.

Vegetarian Diets with Cardiovascular Disease Outcomes: A Systematic Review and Meta-Analyses of Prospective Cohort Studies

2018 ◽  
Vol 42 (5) ◽  
pp. S20
Author(s):  
Andrea Glenn ◽  
Effie Viguiliouk ◽  
Maxine Seider ◽  
Sonia Blanco Mejia ◽  
Cyril Kendall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Prospective Cohort Studies ◽  
Disease Outcomes ◽  
Vegetarian Diets ◽  
Meta Analyses

scholarly journals Adiposity and the risk of rheumatoid arthritis: a systematic review and meta-analysis of cohort studies

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Tomoya Ohno ◽  
Dagfinn Aune ◽  
Alicia K. Heath
Keyword(s):  
Rheumatoid Arthritis ◽  
Systematic Review ◽  
Waist Circumference ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Case Control Studies ◽  
Rheumatoid Arthritis Risk ◽  
Random Effects Models ◽  
Relative Risks ◽  
Meta Analyses

Abstract Several studies have investigated associations between overweight/obesity and risk of developing rheumatoid arthritis, however, the evidence is not entirely consistent, and previous meta-analyses mainly included case–control studies, which can be affected by various biases. We therefore conducted a systematic review and meta-analysis of cohort studies on adiposity and risk of rheumatoid arthritis. Relevant studies were identified by searching PubMed and Embase databases. Random effects models were used to estimate summary relative risks (RRs) and 95% confidence intervals (CIs) for rheumatoid arthritis in relation to different measures of adiposity. Thirteen cohort studies (10 publications) were included. The summary RR per 5 kg/m2 increase in body mass index (BMI) was 1.11 (95% CI 1.05–1.18, I2 = 50%), but the association was restricted to women (1.15, 95% CI 1.08–1.21, I2 = 17%) and not observed in men (0.89, 95% CI 0.73–1.09, I2 = 58%). The summary RR per 5 kg/m2 increment in BMI at age 18 years was 1.17 (95% CI 1.01–1.36, I2 = 26%, n = 3), and per 10 cm increase in waist circumference was 1.13 (95% CI 1.02–1.25, I2 = 44%, n = 2). Higher BMI in middle age, BMI at age 18 years, and waist circumference were associated with increased rheumatoid arthritis risk, suggesting adiposity could be targeted for primary prevention.

scholarly journals Cohorts

2020 ◽  
Vol 23 (2) ◽  
pp. 114-115
Author(s):  
Jaakko Kaprio ◽  
Dorret I. Boomsma
Keyword(s):  
Cohort Studies ◽  
Human Health ◽  
Twin Studies ◽  
Environmental Determinants ◽  
Combine Data ◽  
Replication Studies ◽  
Multiple Exposures ◽  
Meta Analyses ◽  
Multiple Domains ◽  
And Behavior

AbstractCohort studies are essential for conducting large studies of multiple exposures and outcomes in humans. Recently, the ability to combine data from multiple cohorts in, for example, meta-analyses, and the willingness in the genetics community to collaborate to enable replication studies has led to many new insights into the genetic and environmental determinants of human health and behaviors. The contribution of Professor Nicholas Martin to the development of cohort studies, particularly of twin and twin-family studies, over a period of several decades is reviewed. He has contributed to the development and use of both Australian and international resources. The contributions of Australian twin studies to genomewide association projects are multiple, and across multiple domains, from biomarkers, lifestyle and behavior to disorders and disease.

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