scholarly journals Two-dose varicella vaccine effectiveness in China: a meta-analysis and evidence quality assessment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhujiazi Zhang ◽  
Luodan Suo ◽  
Jingbin Pan ◽  
Dan Zhao ◽  
Li Lu
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Varicella Vaccine ◽  
Vaccine Effectiveness ◽  
Healthy Children ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Significant Difference ◽  
Evidence Quality

Abstract Background The objectives of this review were to evaluate the vaccine effectiveness (VE) of the two-dose varicella vaccine for healthy children in China and explore the application of the approach of Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) in observational studies on VE. Methods We searched for observational studies on two-dose varicella VE for children in China aged 1–12 years that were published from 1997 to 2019, and assessed the quality of each study using the Newcastle Ottawa Scale (NOS). We used meta-analysis models to obtain the pooled two-dose VE, and the studies were divided into subgroups and analysed according to whether or not it was an outbreak investigation and its NOS score. The quality of evidence of VEs were rated by approach of the GRADE system. Results A total of 12 studies and 87,196 individuals were included. The pooled two-dose VE was 90% (95% confidence interval [CI]: 69–97%). The VE of outbreak studies (87% [95% CI: 76–93%]) was lower than non-outbreak studies (99% [95% CI: 98–99%]). There was no significant difference in VEs by different NOS quality. The quality of the evidence assessment of pooled two-dose VE was “low”, which was rated down by one category in limitations and publication bias respectively and rated up by two category in large effect. The quality of evidence assessment in subgroup of NOS score ≥ 7 was “moderate”. Conclusions The VE of two-dose varicella vaccine is relatively high in preventing varicella, and is recommended for countries which need further control for varicella. However, higher quality evidence is needed as a supplement for stronger recommendations. The approach of GRADE could be applied for rating the quality of evidence in observational study.

scholarly journals Acupuncture for post-stroke depression: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ran Liu ◽  
Kun Zhang ◽  
Qiu-yu Tong ◽  
Guang-wei Cui ◽  
Wen Ma ◽  
...  
Keyword(s):  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Assessment Development ◽  
Significant Difference ◽  
Post Stroke Depression ◽  
Meta Analyses

Abstract Background Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. Methods An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. Results A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I2 = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I2 = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I2 = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I2 = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. Conclusions The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

scholarly journals Vernakalant for cardioversion of recent-onset atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1159-1166 ◽  
Author(s):  
William F McIntyre ◽  
Jeff S Healey ◽  
Akash K Bhatnagar ◽  
Patrick Wang ◽  
Jacob A Gordon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Meta Analysis ◽  
Structural Heart Disease ◽  
Quality Of Evidence ◽  
Recent Onset ◽  
Assessment Development ◽  
Significant Difference ◽  
Pharmacological Cardioversion

AbstractAimsTo evaluate the efficacy and safety of vernakalant for the cardioversion of atrial fibrillation (AF).Methods and resultsWe reviewed the literature for randomized trials that compared vernakalant to another drug or placebo in patients with AF of onset ≤7 days. We used a random-effects model to combine quantitative data and rated the quality of evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation). From 441 total citations in MEDLINE, EMBASE, and CENTRAL (December 2018), we identified nine trials evaluating 1358 participants. Six trials compared vernakalant to placebo, two trials compared vernakalant to ibutilide, and one trial compared vernakalant to amiodarone. We found significant methodological bias in four trials. For conversion within 90 min, vernakalant was superior to placebo [50% conversion, risk ratio (RR) 5.15; 95% confidence interval (CI); 2.24–11.84, I2 = 91%], whereas we found no significant difference in conversion when vernakalant was compared with an active drug (56% vs. 24% conversion, RR 2.40; 95% CI 0.76–7.58, I2 = 94). Sinus rhythm was maintained at 24 h in 85% (95% CI 80–88%) of patients who converted acutely with vernakalant. Overall, we judged the quality of evidence for efficacy to be low based on inconsistency and suspected publication bias. There was no significant difference in the risk of significant adverse events between vernakalant and comparator (RR 0.95; 95% CI 0.70–1.28, I2 = 0, moderate quality evidence). Vernakalant is safe and effective for rapid and durable restoration of sinus rhythm in patients with recent-onset AF.ConclusionVernakalant should be a first line option for the pharmacological cardioversion of patients with haemodynamically stable recent-onset AF without severe structural heart disease.

scholarly journals The Use of Evidence-Based Acupuncture: Current Evidence

2022 ◽  
Author(s):  
Dedi Ardinata
Keyword(s):  
Clinical Evidence ◽  
Scientific Evidence ◽  
Current Evidence ◽  
Systematic Research ◽  
Evidence Based ◽  
Clinical Expertise ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Evidence Quality

Evidence-based medicine (EBM), which emphasizes that medical decisions must be based on the most recent best evidence, is gaining popularity. Individual clinical expertise is combined with the best available external clinical evidence derived from systematic research in the practice of EBM. The key and core of EBM is the hierarchical system for categorizing evidence. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system divides evidence quality into four categories: high, moderate, low, and very low. GRADE is based on the lowest quality of evidence for any of the outcomes that are critical to making a decision, reducing the risk of mislabeling the overall evidence quality, when evidence for a critical outcome is lacking. This principle is also used in acupuncture as a complementary and integrative treatment modality, but incorporating scientific evidence is more difficult due to a number of factors. The goal of this chapter is to discuss how to establish a clinical evidence system for acupuncture, with a focus on the current quality of evidence for a variety of conditions or diseases.

Urgent-start peritoneal dialysis in chronic kidney disease patients: A systematic review and meta-analysis compared with planned peritoneal dialysis and with urgent-start hemodialysis

2020 ◽  
pp. 089686082091871
Author(s):  
Guo Xieyi ◽  
Tang Xiaohong ◽  
Wu Xiaofang ◽  
Li Zi
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Exit Site Infection ◽  
Quality Of Evidence ◽  
Significant Difference

An increasing number of studies have focused on whether peritoneal dialysis (PD) can be used for the urgent initiation of dialysis in patients with chronic kidney disease (CKD). We performed this systematic review and meta-analysis to evaluate the feasibility and safety of urgent-start PD compared with those of planned PD and urgent-start hemodialysis (HD) in this population. PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), clinicaltrials.gov , and China National Knowledge Infrastructure (CNKI) were searched for relevant studies. Conference abstracts were also searched in relevant websites. The meta-analysis was performed using RevMan 5.3 software. A total of 15 trials involving 2426 participants were identified. The quality of the included studies was fair, but the quality of evidence was very low. Unadjusted meta-analysis showed that urgent-start PD had significantly higher mortality than planned PD, while adjusted meta-analysis did not show a significant difference. Higher incident of leakage and catheter mechanical dysfunction were observed in urgent-start PD. However, peritonitis, exit-site infection, or PD technique survival were comparable between urgent-start and planned PD. The all-cause mortality was comparable in urgent-start PD and urgent-start HD. Bacteremia was significantly lower in the urgent-start PD group than with urgent-start HD. Based on limited evidences, PD may be a viable alternative to HD for CKD patients requiring urgent-start dialysis. Because of the inconsistent results and the low quality of evidence, a definitive conclusion could not be drawn for whether urgent-start PD was comparable with planned PD. Therefore, high-quality and large-scale studies are needed in the future.

scholarly journals Comparison of Submucosal With Intramuscular or Intravenous Administration of Dexamethasone for Third Molar Surgeries: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Chengyu Hou ◽  
Feng Liu ◽  
Chengbin Liu
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Third Molar ◽  
Pooled Analysis ◽  
Third Molar Surgery ◽  
Quality Of Evidence ◽  
Pain Scores ◽  
Significant Difference ◽  
Mandibular Third Molar Surgery

Objective: The study aimed to review evidence on the efficacy of submucosal (SM) administration vs. intravenous (IV) or intramuscular (IM) route of injections of dexamethasone for improving outcomes after mandibular third molar surgery.Methods: PubMed, Embase, CENTRAL, and Google Scholar were searched for randomized controlled trials (RCTs) up to 20th May 2021. Early (2–3 days) and late (7 days) outcomes were compared between SM vs. IV or IM dexamethasone. Quality of evidence was assessed based on GRADE.Results: Thirteen trials were included in the systematic review and 10 in the meta-analysis. Meta-analysis indicated a significant reduction in early pain with IV dexamethasone but no such difference for late pain compared to the SM group. There was no difference in early and late swelling scores between the SM and IV groups. Pooled analysis indicated no significant difference in early and late trismus between SM and IV groups. Comparing SM with IM dexamethasone, there was no significant difference in early and late pain scores. Swelling in the early and late postoperative periods was not significantly different between the two groups. There was no significant difference in early and late trismus between SM and IM groups. The quality of evidence was low for all outcomes.Conclusion: Low-quality evidence suggests that SM infiltration of dexamethasone results in similar outcomes as compared to IV or IM administration of the drug after third molar surgeries. Further high-quality RCTs are needed to corroborate the current conclusions.

Acupuncture for post-stroke cognitive impairment: a systematic review and meta-analysis

2021 ◽  
pp. 096452842110095
Author(s):  
Xu Kuang ◽  
Wenjuan Fan ◽  
Jiawei Hu ◽  
Liqun Wu ◽  
Wei Yi ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Qualitative Synthesis ◽  
China National Knowledge Infrastructure ◽  
Quality Of Evidence ◽  
Post Stroke ◽  
Assessment Development

Objectives: The aim of this study was to evaluate the effectiveness and safety of acupuncture for the treatment of post-stroke cognitive impairment (PSCI). Methods: The Cochrane Library, Embase, Medline, China National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical (VIP), Wanfang, and Chinese Biological Medicine (CBM) databases were electronically searched from their inception to 10 April 2019. The Montreal Cognitive Assessment (MoCA) scale and Mini-Mental State Examination (MMSE) scale were used as outcomes to assess effectiveness with respect to cognitive function. Assessment of risk of bias (ROB) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment were performed by two reviewers independently. Data were analyzed using Review Manager (RevMan) 5.3. Results: A total of 28 trials with 2144 participants were included in the qualitative synthesis and meta-analysis. Four of the 28 trials (14%) were assessed as being at overall low ROB, 24 of the 28 trials (86%) were assessed as having overall high ROB. The quality of evidence for both MoCA and MMSE were deemed to be very low by the GRADE criteria. Results indicated that acupuncture groups may be benefiting more than non-acupuncture groups with respect to variation of MoCA scores (merged mean difference (MMD): 2.66, 95% confidence interval (CI): 2.18 to 3.13, p < 0.00001; heterogeneity: χ2 = 35.52, p = 0.0007, I2 = 63%), and the heterogeneity decreased in both subgroup analysis and sensitivity analysis. In addition, acupuncture groups might be benefiting more than non-acupuncture groups in terms of changes in MMSE score (MMD = 2.97, 95% CI = 2.13 to 3.80, p < 0.00001; heterogeneity: χ2 = 269.75; p < 0.00001; I2 = 92%), and the heterogeneity decreased in subgroup analysis. Only one RCT addressed adverse events, and the symptoms were mild and did not affect treatment and evaluation. Conclusion: Acupuncture could be effective and safe for PSCI. Nevertheless, the results should be interpreted cautiously due to the high ROB of included trials and very low quality of evidence for assessed outcomes.

Impaired Interparental Relationships in Families of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)

2019 ◽  
Vol 227 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Lena Weyers ◽  
Martina Zemp ◽  
Georg W. Alpers
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Family Relationships ◽  
Attention Deficit ◽  
Meta Analysis ◽  
Healthy Children ◽  
Hyperactivity Disorder ◽  
Oppositional Defiant ◽  
Significant Difference

Abstract. Research on attention-deficit/hyperactivity disorder (ADHD) in children and adolescents has traditionally focused on the genetic and neurobiological aspects of the disorder, but the role of family relationships has been much less systematically examined. There is growing evidence that the quality of interparental relationships and a child’s ADHD symptoms are reciprocally related. Because the literature appears to be inconsistent, this meta-analysis aims to summarize previous research and assess whether there are robust differences in the quality of interparental relationships between parents of children with ADHD and parents of healthy children. This meta-analysis of 15 studies with 43 effect sizes revealed a small but significant difference ( d = .24), which indicates that parents of a child with ADHD report poorer relationship quality than parents of healthy children. This effect was moderated by the child’s age and did not depend on whether the child had a comorbid oppositional defiant disorder (ODD) or conduct disorder (CD). The causality of this relationship has yet to be determined.

Doing no harm: Addressing the quality of evidence in translating research to practice in preliminary research fields

2017 ◽  
Vol 5 (4) ◽  
pp. 490
Author(s):  
Mei'En Lim ◽  
Corrine Reid
Keyword(s):  
Research Evaluation ◽  
Evidence Base ◽  
Current Evidence ◽  
Rating Systems ◽  
Quality Of Evidence ◽  
Assessment Development ◽  
Research Fields ◽  
Evidence Quality ◽  
Evidence Rating

Background: Current evidence appraisal rating systems, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, are oriented toward and anchored by randomized controlled trials (RCTs) as the gold standard methodology. In many fields, this standard of evidence is rarely, if ever, met. Often, research at the clinical application end of the translational process is embedded in real world practice that does not lend itself to RCTs and is characterised by more pragmatic research using mixed methodologies. Arguably, accountability through research evaluation is even more important in such cases where research design is preliminary and clinical impact is, often, already a reality. Further, practice translation must be privileged as the central goal of the research synthesis under such circumstances in that the destination of all clinical science is the person of the patient.. Methods: In response to these demand characteristics, a practitioner-informed research framework was used to drive and pilot development of an evidence quality grading system that could accommodate a disparate and oblique evidence base. Reid’s person-centered framework was used to establish whether clinician-derived criteria for quality research practice had been met. Results: This brief report presents the Quality of Evidence Rating System (QERS) in the hope of facilitating discussion about accountability pathways for translational scientist-practitioners.Conclusion: The QERS provides a scaffold to help when looking for evidence that researchers have consciously addressed the issues of evidence quality when reporting their research in the published literature.

scholarly journals Effectiveness of miniscrew-supported maxillary incisor intrusion in deep-bite correction: A systematic review and meta-analysis

2019 ◽  
Vol 90 (2) ◽  
pp. 291-304 ◽  
Author(s):  
Rami Sosly ◽  
Hisham Mohammed ◽  
Mumen Z Rizk ◽  
Eias Jamous ◽  
Ahmad G. Qaisi ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Root Resorption ◽  
Data Extraction ◽  
Meta Analysis ◽  
Included Study ◽  
Maxillary Incisor ◽  
Deep Bite ◽  
Quality Of Evidence ◽  
Significant Difference

ABSTRACT Objectives: To evaluate systematically the effectiveness of miniscrew-supported maxillary incisor intrusion compared with other nonsurgical intrusive mechanics for deep-bite correction. Materials and Methods: Unrestricted electronic searches in Embase, Web of Science, MEDLINE, LILACS, and Cochrane's CENTRAL as well as manual searches were conducted up to August 2019. Only randomized clinical trials (RCTs) were included. Study selection, data extraction, and bias assessment were done by two independent reviewers. The Cochrane risk-of-bias tool was used, and the quality of evidence was graded using the GRADE approach. A random-effects meta-analysis of continuous data, with its 95% confidence intervals (CIs), was used. Results: Seven RCTs were included in the quantitative synthesis, and the overall quality of evidence was very low to low. When compared with intrusion arches, miniscrews resulted in a more efficient deep-bite reduction with a standardized mean difference (SMD) of −0.48 (95% CI, −0.89 to −0.07). When miniscrews were used, a statistically significant difference was observed favoring less maxillary molar extrusion (SMD, −0.86; 95% CI, −1.46 to −0.27) and more incisor intrusion as measured from centroid to palatal plane (SMD, −0.95; 95% CI, −1.41 to −0.49). Results also showed a statistically nonsignificant difference regarding the amount of resultant root resorption between miniscrews and intrusion arches. Conclusions: There is weak evidence indicating efficient deep-bite correction using miniscrews. Root resorption seems to be an associated adverse effect that occurs regardless of the intrusive mechanics used. These conclusions should be viewed with great caution as further well-designed long-term research is recommended.

scholarly journals Systematic Review and Meta-Analysis of Postoperative Antibiotics for Patients with a Complex Appendicitis

2019 ◽  
Vol 37 (2) ◽  
pp. 101-110 ◽  
Author(s):  
Anne Loes van den Boom ◽  
Elisabeth M.L. de Wijkerslooth ◽  
Bas P.L. Wijnhoven
Keyword(s):  
Antibiotic Treatment ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Infectious Complications ◽  
Random Effects Model ◽  
Assessment Development ◽  
Significant Difference ◽  
Secondary Endpoints ◽  
Event Rates

Postoperative antibiotics are recommended after appendectomy for complex appendicitis to reduce infectious complications. The duration of this treatment varies considerably between and even within institutions. The aim of this review was to critically appraise studies on duration of antibiotic treatment following appendectomy for complex appendicitis. A systematic literature search according to the PRISMA guidelines was performed. Comparative studies evaluating different durations of postoperative antibiotic therapy. Primary endpoint was intra-abdominal abscess (IAA) after appendectomy. Secondary endpoints were surgical site infection, readmission and length of hospital stay. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Pooled event rates were calculated using a random-effects model. Nine studies reporting 2006 patients with complex appendicitis were included. The methodological quality of the included articles was poor. IAA was seen in 138 patients (8,6%). Meta-analysis revealed a statistically significant difference in IAA incidence between antibiotic treatment of ≤5 vs. >5 days (risk ratio (OR) 0.36 [95% CI 0.23–0.57] (p < 0.0001)) but not between ≤3 vs. >3 days (OR 0.81 [95% CI 0.38–1.74] (p = 0.59)). Descriptive statistics were used for secondary endpoints. The duration of postoperative antibiotic treatment is not associated with IAA following appendectomy for complex appendicitis.

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