scholarly journals Interventions in overcrowding of emergency departments: an overview of systematic reviews

2020 ◽  
Vol 54 ◽  
pp. 66
Author(s):  
Roberto José Bittencourt ◽  
Angelo De Medeiros Stevanato ◽  
Carolina Thomé N. M. Bragança ◽  
Leila Bernarda Donato Gottems ◽  
Gisele O’Dwyer
Keyword(s):  
Systematic Reviews ◽  
Emergency Departments ◽  
Methodological Quality ◽  
Cochrane Library ◽  
Narrative Synthesis ◽  
Work Processes ◽  
Overview Of Systematic Reviews ◽  
The Subject ◽  
Positive Effect

OBJECTIVE: To present an overview of systematic reviews on throughput interventions to solve the overcrowding of emergency departments. METHODS: Electronic searches for reviews published between 2007 and 2018 were made on PubMed, Cochrane Library, EMBASE, Health Systems Evidence, CINAHL, SciELO, LILACS, Google Scholar and the CAPES periodicals portal. Data of the included studies was extracted into a pre-formatted sheet and their methodological quality was assessed using AMSTAR 2 tool. Eventually, 15 systematic reviews were included for the narrative synthesis. RESULTS: The interventions were grouped into four categories: (1) strengthening of the triage service; (2) strengthening of the ED’s team; (3) creation of new care zones; (4) change in ED’s work processes. All studies observed positive effect on patient’s length of stay, expect for one, which had positive effect on other indicators. According to AMSTAR 2 criteria, eight revisions were considered of high or moderate methodological quality and seven, low or critically low quality. There was a clear improvement in the quality of the studies, with an improvement in focus and methodology after two decades of systematic studies on the subject. CONCLUSIONS: Despite some limitations, the evidence presented on this overview can be considered the cutting edge of current scientific knowledge on the topic.

Non-Vitamin K Antagonist Oral Anticoagulants in Pulmonary Embolism: An Overview of Systematic Reviews

2020 ◽  
Vol 26 (23) ◽  
pp. 2686-2691 ◽  
Author(s):  
Ioannis Doundoulakis ◽  
Christina Antza ◽  
Haralambos Karvounis ◽  
George Giannakoulas
Keyword(s):  
Pulmonary Embolism ◽  
Vitamin K ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Randomized Clinical Trials ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Language Restriction ◽  
Overview Of Systematic Reviews

Background: Anticoagulation in patients with pulmonary embolism. Objective: To identify how non-vitamin K antagonist oral anticoagulants are associated with multiple outcomes in patients with pulmonary embolism. Methods: We performed a systematic search of systematic reviews via multiple electronic databases from inception to August 19th, 2019, without language restriction. Two authors independently extracted data and assessed the methodological quality of the included systematic reviews using the ROBIS tool. Results: We found twelve systematic reviews. Eleven SRs collected their data from randomized clinical trials and one from observational studies. All the included studies were published between 2014 and 2019 in English. The methodological quality of the 12 systematic reviews was low to high. None of the systematic reviews, which are included in our overview of systematic reviews, has evaluated the overall quality of evidence outcome using the Grading of Recommendations Assessments, Development and Evaluation (GRADE) approach. Conclusion: This is the first effort to summarize evidence about non-vitamin K antagonist oral anticoagulants in an overview of systematic reviews focusing exclusively on patients with pulmonary embolism. The evidence suggests that the non-vitamin K antagonist oral anticoagulants seem to be more effective and safer than a dualdrug approach with LMWH- VKA.

scholarly journals Telemonitoring Interventions in COPD Patients: Overview of Systematic Reviews

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Xuanlin Li ◽  
Yang Xie ◽  
Hulei Zhao ◽  
Hailong Zhang ◽  
Xueqing Yu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Exercise Capacity ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Grade System ◽  
Cochrane Library ◽  
Exacerbation Rate ◽  
Copd Patients

Objective. The role of telemonitoring interventions (TIs) for chronic obstructive pulmonary disease (COPD) has been studied in many systematic reviews (SRs) and meta-analyses (MAs), but robust conclusions have not been reached due to wide variations in scopes, qualities, and outcomes. The aim of this overview was to determine the effectiveness of TIs on COPD patients. Methods. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for all reviews on the topic of TI in treating COPD from inception to July 8, 2019, without restrictions on language. According to the inclusion and exclusion criteria, the retrieved literature studies were screened to select SRs and MAs of randomized control trials (RCTs) that evaluated the effects of TIs in COPD patients. The methodological quality of SRs and MAs was assessed with the AMSTAR-2 tool, and the strength of evidence was assessed with the grades of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes in terms of mortality, quality of life (SGRQ total scores), exercise capacity (6MWD), and exacerbation-related outcomes (hospitalizations, exacerbation rate, and emergency room visits). Results. Our overview included eight SRs and MAs published in 2011 to 2019, from 95 RCTs involving 10632 participants. After strict evaluation by the AMSTAR-2 tool, 75% of the SRs and MAs in this overview had either low or critically low methodological quality. The effects of TIs for COPD on mortality, quality of life, exercise capacity, and exacerbation-related outcomes are limited, and all of these outcomes scored either low or very low quality of evidence on the GRADE system. Conclusions. There might be insufficient evidence to support the effectiveness of TIs for COPD currently, but the results of this overview should be interpreted dialectically and prudently, and the role of TIs in COPD needs further exploration.

scholarly journals Assessing the methodological quality of systematic reviews using the AMSTAR tool

2020 ◽  
Author(s):  
Ana Beatriz Pizarro ◽  
Sebastián Carvajal ◽  
Adriana Buitrago-López
Keyword(s):  
Systematic Reviews ◽  
Health Professionals ◽  
Methodological Quality ◽  
Critical Appraisal ◽  
Internal Validity ◽  
Critical Assessment ◽  
Cochrane Library ◽  
Publication Date ◽  
Review Of Literature

Introduction: Making decisions based on evidence has been a challenge for health professionals, given the need to have the tools and skills to carry out a critical appraisal of the evidence and assess the validity of the results. Systematic reviews of the literature (SRL) have been used widely to answer questions in the clinical field. Tools have been developed that support the appraisal of the quality of the studies. AMSTAR is one of these, validated and supported by reproducible evidence, which guides the methodological quality of the SRL. Objectives: To show a historical, theoretical and practical guide for critical assessment of systematic reviews using AMSTAR to guide the argumental bases for their use according to the components of this methodological structure in health research, and to provide practical examples of how to apply this checklist. Methods: We conducted a non-exhaustive review of literature in Pubmed and Cochrane Library using “AMSTAR” and “Systematic Reviews” as free terms without language or publication date limit; we also collected information from experts in the evaluation of the quality of the evidence. Conclusions: AMSTAR is an instrument used, validated and supported by reproducible evidence for the evaluation of the internal validity of systematic reviews of the literature. It consists of 16 items that assess the overall methodological quality of an SRL. It is currently used indiscriminately and favorably, but it is not exempt from limitations and future updates based on new reproducibility and validation studies.

scholarly journals Effectiveness of feeding supplementation in preterm infants: an overview of systematic reviews

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Keqin Liu ◽  
Jiaxin Tao ◽  
Jixin Yang ◽  
Yufeng Li ◽  
Yanwei Su ◽  
...  
Keyword(s):  
Health Outcomes ◽  
Preterm Infants ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Data Extraction ◽  
Cochrane Library ◽  
Qualitative Synthesis ◽  
Term Infants ◽  
Online Library

Abstract Background Preterm infants have higher nutrition needs than term infants. The effectiveness of various feeding supplementation was assessed by the improvement of health outcomes in single specific systematic reviews (SRs). The aim of this review was to comprehensively describe the effectiveness of feeding supplementation in promoting health outcomes of preterm infants. Methods A literature search was conducted in the PUBMED, EMBASE, Science Direct, Cochrane library, Web of Science, and Wiley online library. SRs selection followed clear inclusion and exclusion criteria. Pairs of reviewers independently applied the criteria to both titles/abstracts and full texts. Screening and data extraction were performed by using the advanced tables. The methodological quality of SRs and the quality of the evidence were carried out according to the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool and the Grades of Recommendation, Assessment, Development, and Evaluation guidelines (GRADE) respectively. A qualitative synthesis of evidence is presented. Results Seventeen SRs were included in the review. Fifteen kinds of feeding supplementation were reported in the SRs. In preterm infants, the effectiveness of feeding supplementation in addition to regular breast-feeding was mainly shown in six aspects: physical health, neurodevelopment, biochemical outcomes, other health outcomes, morbidity and all-cause mortality. And the effectiveness of the interventions on health outcomes in preterm infants was found by most systematic reviews. The methodological quality of all the included SRs was high, and most of the evidences was of low or very low quality. Conclusions Our results will allow a better understanding of the feeding supplementation in preterm infants. Although the feeling supplements may improve the health outcomes of in preterm infants, the existing evidence is uncertain. Therefore, the clinical use of these supplements should be considered cautiously and more well-designed RCTs are still needed to further address the unsolved problems of the included SRs.

scholarly journals Overview of systematic reviews - a new type of study. Part II

2014 ◽  
Vol 133 (3) ◽  
pp. 206-217 ◽  
Author(s):  
Valter Silva ◽  
Antonio Jose Grande ◽  
Alan Pedrosa Viegas de Carvalho ◽  
Ana Luiza Cabrera Martimbianco ◽  
Rachel Riera
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Overview Of Systematic Reviews ◽  
New Type ◽  
The Mean ◽  
Meta Analyses ◽  
General Profile

CONTEXT AND OBJECTIVE: Overviews of Systematic Reviews (OoRs) are a new type of study in which multiple evidence from systematic reviews (SRs) is compiled into an accessible and useful document. The aim here was to describe the state of the art and critically assess Cochrane OoRs that have been published.DESIGN AND SETTING: Descriptive study conducted at a research center.METHODS: The OoRs identified through the filter developed in Part I of this study were evaluated in five domains: methodological quality; quality of evidence; implications for practice; general profile of OoRs; and length of work.RESULTS: All 13 OoRs included had high methodological quality. Some OoRs did not present sufficient data to judge the quality of evidence; using sensitivity analysis, the quality of evidence of the OoRs increased. Regarding implications for practice, 64% of the interventions were judged as beneficial or harmful, while 36% of them showed insufficient evidence for judgment. It is expected (with 95% confidence interval) that one OoR will include 9,462 to 64,469 patients, 9 to 29 systematic reviews and 80 to 344 primary studies, and assess 6 to 21 interventions; and that 50 to 92% of OoRs will produce meta-analysis. The OoRs generated 2 to 26 meta-analyses over a period of 18 to 31 months.CONCLUSION: The OoRs presented high methodological quality; the quality of evidence tended to be moderate/high; most interventions were judged to be beneficial/harmful; the mean length of work was 24 months. The OoR profile adds power to decision-making.

scholarly journals Exercise/physical activity and health outcomes: an overview of Cochrane systematic reviews

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pawel Posadzki ◽  
Dawid Pieper ◽  
Ram Bajpai ◽  
Hubert Makaruk ◽  
Nadja Könsgen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Effect Size ◽  
Methodological Quality ◽  
Prediction Interval ◽  
Mortality Rates ◽  
Noncommunicable Diseases ◽  
Cochrane Library

Abstract Background Sedentary lifestyle is a major risk factor for noncommunicable diseases such as cardiovascular diseases, cancer and diabetes. It has been estimated that approximately 3.2 million deaths each year are attributable to insufficient levels of physical activity. We evaluated the available evidence from Cochrane systematic reviews (CSRs) on the effectiveness of exercise/physical activity for various health outcomes. Methods Overview and meta-analysis. The Cochrane Library was searched from 01.01.2000 to issue 1, 2019. No language restrictions were imposed. Only CSRs of randomised controlled trials (RCTs) were included. Both healthy individuals, those at risk of a disease, and medically compromised patients of any age and gender were eligible. We evaluated any type of exercise or physical activity interventions; against any types of controls; and measuring any type of health-related outcome measures. The AMSTAR-2 tool for assessing the methodological quality of the included studies was utilised. Results Hundred and fifty CSRs met the inclusion criteria. There were 54 different conditions. Majority of CSRs were of high methodological quality. Hundred and thirty CSRs employed meta-analytic techniques and 20 did not. Limitations for studies were the most common reasons for downgrading the quality of the evidence. Based on 10 CSRs and 187 RCTs with 27,671 participants, there was a 13% reduction in mortality rates risk ratio (RR) 0.87 [95% confidence intervals (CI) 0.78 to 0.96]; I2 = 26.6%, [prediction interval (PI) 0.70, 1.07], median effect size (MES) = 0.93 [interquartile range (IQR) 0.81, 1.00]. Data from 15 CSRs and 408 RCTs with 32,984 participants showed a small improvement in quality of life (QOL) standardised mean difference (SMD) 0.18 [95% CI 0.08, 0.28]; I2 = 74.3%; PI -0.18, 0.53], MES = 0.20 [IQR 0.07, 0.39]. Subgroup analyses by the type of condition showed that the magnitude of effect size was the largest among patients with mental health conditions. Conclusion There is a plethora of CSRs evaluating the effectiveness of physical activity/exercise. The evidence suggests that physical activity/exercise reduces mortality rates and improves QOL with minimal or no safety concerns. Trial registration Registered in PROSPERO (CRD42019120295) on 10th January 2019.

Compound Danshen (Salvia miltiorrhiza) Dripping Pill for Coronary Heart Disease: An Overview of Systematic Reviews

2015 ◽  
Vol 43 (01) ◽  
pp. 25-43 ◽  
Author(s):  
Jing Luo ◽  
Weijiang Song ◽  
Guoyan Yang ◽  
Hao Xu ◽  
Keji Chen
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Systematic Reviews ◽  
Salvia Miltiorrhiza ◽  
Cochrane Library ◽  
Quality Of Evidence ◽  
Overview Of Systematic Reviews ◽  
Potential Benefits ◽  
The Cochrane Library

Compound Danshen dripping pill (CDDP) is commonly used to treat coronary heart disease (CHD) in China. However, clinical practice has not been informed by evidence from relevant systematic reviews (SRs). This overview aims at summarizing evidence from SRs on CDDP for the treatment of CHD. We included SRs of randomized controlled trials (RCTs) on CDDP in treating CHD until March 2014 by searching the Cochrane Library, PubMed, EMBASE and four Chinese databases. Data were extracted according to a pre-designed form. We assessed the quality of SRs according to AMSTAR and graded the quality of evidence in the included SRs using the GRADE approach. All data analyses were descriptive. About 13 SRs involving a total of 34,071 participants with angina or acute myocardial infarction (AMI) were included. Few SRs assessed endpoints (5/13, 38.5%) and quality of life (QOL) (4/13, 30.8%). Most of the SRs suggested that CDDP had potential benefits for patients with CHD, such as improving symptoms and electrocardiogram (ECG) results, with few adverse reactions, while benefits in endpoints were unproved. Moreover, the overall quality of evidence in the SRs was poor, ranging from "very low" to "moderate", and most of the included SRs were of "low" (3/13, 23.1%) or "moderate" (9/13, 69.2%) quality with many serious flaws. Current SRs suggested potential benefits of CDDP for the treatment of CHD. However, high-quality evidence is warranted to support the application of CDDP in treating CHD.

scholarly journals A Systematic Overview of Reviews for Complementary and Alternative Therapies in the Treatment of the Fibromyalgia Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-13 ◽  
Author(s):  
Romy Lauche ◽  
Holger Cramer ◽  
Winfried Häuser ◽  
Gustav Dobos ◽  
Jost Langhorst
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Fibromyalgia Syndrome ◽  
Data Extraction ◽  
Scientific Evidence ◽  
Cochrane Library ◽  
Overview Of Reviews ◽  
Systematic Overview ◽  
Complementary And Alternative

Objectives.This systematic overview of reviews aimed to summarize evidence and methodological quality from systematic reviews of complementary and alternative medicine (CAM) for the fibromyalgia syndrome (FMS).Methods.The PubMed/MEDLINE, Cochrane Library, and Scopus databases were screened from their inception to Sept 2013 to identify systematic reviews and meta-analyses of CAM interventions for FMS. Methodological quality of reviews was rated using the AMSTAR instrument.Results.Altogether 25 systematic reviews were found; they investigated the evidence of CAM in general, exercised-based CAM therapies, manipulative therapies, Mind/Body therapies, acupuncture, hydrotherapy, phytotherapy, and homeopathy. Methodological quality of reviews ranged from lowest to highest possible quality. Consistently positive results were found for tai chi, yoga, meditation and mindfulness-based interventions, hypnosis or guided imagery, electromyogram (EMG) biofeedback, and balneotherapy/hydrotherapy. Inconsistent results concerned qigong, acupuncture, chiropractic interventions, electroencephalogram (EEG) biofeedback, and nutritional supplements. Inconclusive results were found for homeopathy and phytotherapy. Major methodological flaws included missing details on data extraction process, included or excluded studies, study details, and adaption of conclusions based on quality assessment.Conclusions.Despite a growing body of scientific evidence of CAM therapies for the management of FMS systematic reviews still show methodological flaws limiting definite conclusions about their efficacy and safety.

scholarly journals Interventions for Treating Tennis Elbow: An Overview of Systematic Reviews in the Past Ten Years

2020 ◽  
Author(s):  
Xue Wang ◽  
Jun Xiong ◽  
Jun Yang ◽  
Ting Yuan
Keyword(s):  
Systematic Reviews ◽  
Comparative Studies ◽  
Methodological Quality ◽  
Tennis Elbow ◽  
Meta Analysis ◽  
Reporting Quality ◽  
Research Process ◽  
Cochrane Library ◽  
Different Types

Abstract purpose: Tennis elbow is a common orthopedic disease, and there are many ways to treat it. This overview aimed to summarize the evidence of different treatments for tennis elbows, so as to provide the best guidance for clinical treatment.Methods: Use computer to search CNKI, WanFang database, WeiPu database, CBM database, PubMed, Cochrane Library and Embase from the time of establishment to May 31, 2019.Te Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and latest Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklists were used to assess reporting characteristics and methodological quality, respectively.Results: A total of 37 references were included. Methodological quality and reporting quality were unsatisfactory. Methodological quality was generally low and many key items were not reported. Some research reports are of high quality, but there is no trial registration and protocol written in advance, which may lead to some bias in the research process. The most frequent problems included non-registration of study protocol, absence of a list of excluded studies, and unclear acknowledgment of conflicts of interests. The different types of interventions included have been shown to relieve pain, improve quality of life, and restore elbow function, but there has been a lack of comparative studies.Conclusion: The reporting and methodological quality of systematic reviews and meta-analysis studies were sub-optimal, which demands further improvement. Comparative studies of different types of interventions are needed to determine unclear.PROSPERO registration number: CRD42015017071

scholarly journals Effectiveness of pharmacotherapy for smoking cessation: Umbrella review and quality assessment of systematic reviews

2020 ◽  
Author(s):  
Alemu Sufa Melka ◽  
Catherine L Chojenta ◽  
Elizabeth G Holliday ◽  
Ayele G Bali ◽  
Deborah J Loxton
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Systematic Reviews ◽  
Methodological Quality ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Nicotine Replacement ◽  
Risk Of Cancer

Abstract Background : In the long term, smoking cessation can decrease the risk of cancer, stroke, and heart attacks and improve overall survival. This umbrella review aimed to assess the effect of pharmacological interventions on smoking cessation and to evaluate the methodological quality of previously conducted systematic reviews. Methods: Databases including the Cochrane library, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, Scopus and Google Scholar were used to retrieve reviews. Systematic reviews that included only randomized controlled trials designed to assess pharmacotherapeutic interventions supporting abstinence from smoking were considered in this umbrella review. The methodological quality of the included reviews was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool, which contains 16 domains. Two authors (AM, AB) screened the titles and abstracts of all reviews obtained by the search strategy, assessed the full text of selected articles for inclusion and extracted data independently. Two authors (AM, AB) also performed a quality appraisal independently. The findings of the studies were narrated qualitatively to describe the evidence regarding the effectiveness of pharmacotherapies for smoking cessation. Results: Ten reviews were included in this umbrella review . Most of the reviews included in this review reported that Nicotine Replacement Therapy (NRT), bupropion and varenicline and cytisine were effective for smoking cessation. The combination of a nicotine patch with other nicotine formulations was also more effective than monotherapy. Similarly, the combination of nicotine with the non-nicotine therapy varenicline was found to be more effective than varenicline alone. However, the opioid antagonist naltrexone alone was not found to be effective for smoking cessation nor in combination with nicotine replacement therapy. Based on the AMSTAR 2 rating, one review scored high quality, two scored moderate quality, four scored low quality, and three scored critically low quality. Conclusions: This review revealed that drugs approved by the US Food and Drug Administration (FDA) are effective for smoking cessation. A combination of nicotine patches with other nicotine formulations was also effective for smoking cessation compared to nicotine monotherapy.

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