scholarly journals How can clinicians choose between conflicting and discordant systematic reviews? A replication study of the Jadad algorithm

2021 ◽  
Author(s):  
Carole Lunny ◽  
Sai Surabi Thirugnanasampanthar ◽  
Sal Kanji ◽  
Nicola Ferri ◽  
Dawid Pieper ◽  
...  
Keyword(s):  
Public Health ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Risk Of Bias ◽  
Consensus Building ◽  
Policy Makers ◽  
Cochrane Database ◽  
Clinical Questions ◽  
Consistent Approach ◽  
Policy Question

Abstract Introduction: The exponential growth of published SRs (SRs) presents challenges for clinicians seeking to answer clinical questions. In 1997, an algorithm was created by Jadad et al. to choose the best SR across multiple but similar SRs with conflicting results. Our study aims to replicate assessments done by authors using the Jadad algorithm to determine: (i) if we chose the same SR as the authors; and (ii) if we would reach the same results.Methods and Analysis: We searched MEDLINE, Epistemonikos, and Cochrane Database of SRs. We included any study using the Jadad algorithm. We used consensus building strategies to operationalise the algorithm and to ensure a consistent approach to interpretation.Results: We identified 21 studies that used the Jadad algorithm to choose one or more SRs. In 62% (13/21) of cases, we were unable to replicate the Jadad assessment and ultimately chose a different SR than the authors. Overall, 18 out of the 21 (86%) independent Jadad assessments agreed in direction of the findings despite 13 having chosen a different SR.Conclusions: Our results suggest that the Jadad algorithm is not reproducible between users as there are no prescriptive instructions about how to operationalise the algorithm. In the absence of a validated algorithm, we recommend that healthcare providers, policy makers, patients and researchers address conflicts between review findings by choosing the SR(s) with meta-analysis of RCTs that most closely resemble their clinical, public health, or policy question, are the most recent, comprehensive (i.e. in terms of number of included RCTs), and at the lowest risk of bias.

scholarly journals Estimating the extent of asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis

2020 ◽  
Author(s):  
Oyungerel Byambasuren ◽  
Magnolia Cardona ◽  
Katy Bell ◽  
Justin Clark ◽  
Mary-Louise McLaws ◽  
...  
Keyword(s):  
At Risk ◽  
Meta Analysis ◽  
Aged Care ◽  
Fixed Effect ◽  
Risk Of Bias ◽  
Mitigation Measures ◽  
Policy Makers ◽  
Random Effects Models ◽  
Transmission Rates ◽  
Community Transmission

AbstractBackgroundThe prevalence of true asymptomatic COVID-19 cases is critical to policy makers considering the effectiveness of mitigation measures against the SARS-CoV-2 pandemic. We aimed to synthesize all available research on the asymptomatic rates and transmission rates where possible.MethodsWe searched PubMed, Embase, Cochrane COVID-19 trials, and Europe PMC (which covers pre-print platforms such as MedRxiv). We included primary studies reporting on asymptomatic prevalence where: (a) the sample frame includes at-risk population, and (b) there was sufficiently long follow up to identify pre-symptomatic cases. Meta-analysis used fixed effect and random effects models. We assessed risk of bias by combination of questions adapted from risk of bias tools for prevalence and diagnostic accuracy studies.ResultsWe screened 998 articles and included nine low risk-of-bias studies from six countries that tested 21,035 at-risk people, of which 559 were positive and 83 were asymptomatic. Diagnosis in all studies was confirmed using a RT-qPCR test. The proportion of asymptomatic cases ranged from 4% to 41%. Meta-analysis (fixed effect) found that the proportion of asymptomatic cases was 15% (95% CI: 12% - 18%) overall; higher in non-aged care 16% (13% - 19%), and lower in long-term aged care 8% (3% - 18%). Four studies provided direct evidence of forward transmission of the infection by asymptomatic cases but suggested considerably lower rates than symptomatic cases.DiscussionOur estimates of the prevalence of asymptomatic COVID-19 cases and asymptomatic transmission rates are lower than many highly publicized studies, but still sufficient to warrant policy attention. Further robust epidemiological evidence is urgently needed, including in sub-populations such as children, to better understand the importance of asymptomatic cases for driving spread of the pandemic.FundingOB is supported by NHMRC Grant APP1106452. PG is supported by NHMRC Australian Fellowship grant 1080042. KB was supported by NHMRC Fellowship grant 1174523. All authors had full access to all data and agreed to final manuscript to be submitted for publication. There was no funding source for this study.

scholarly journals Analgesics for Dental Implants: A Systematic Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Matteo Melini ◽  
Andrea Forni ◽  
Francesco Cavallin ◽  
Matteo Parotto ◽  
Gastone Zanette
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Dental Implant ◽  
Oral Surgery ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Postoperative Outcomes ◽  
Patient’S Satisfaction ◽  
Cochrane Database ◽  
Dental Implant Surgery

Postsurgical pain is commonly associated with dental and oral surgery, and the use of analgesics has been investigated in the management of postoperative pain. This systematic review summarizes available evidence on analgesics used to manage dental implant surgery postoperative pain, to identify best therapeutic protocols and knowledge gap. A comprehensive search was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews through May 2020. Only randomized controlled trials were included. PRISMA guidelines were followed, and risk of bias was appraised using Cochrane RoB2 tool. Eleven trials (762 patients overall) were included. Some aspects limited the feasibility of a meaningful meta-analysis; thus, a narrative synthesis was conducted. Risk of bias was low in four studies and high in two studies, while five studies raised some concerns due to the randomization process. Analgesic use seemed to be associated with improved postoperative outcomes (pain, patient’s satisfaction, and need for rescue medication) when compared to placebo. Overall, this review suggests that the administration of analgesics may provide some advantages in the management of postoperative outcomes after dental implant placement, while indications about the best analgesics cannot be provided.

scholarly journals Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study

2020 ◽  
Vol 12 ◽  
pp. 1759720X2095996
Author(s):  
Irene XY Wu ◽  
Huan Wang ◽  
Lin Zhu ◽  
Yancong Chen ◽  
Charlene HL Wong ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
Random Sequence ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Risk Of Bias ◽  
Sectional Study ◽  
Cross Sectional ◽  
Cochrane Reviews

Background: Healthcare providers need reliable evidence for supporting the adoption of new interventions, of which the source of evidence often originates from systematic reviews (SRs). However, little assessment on the rigor of SRs related to osteoarthritis interventions has been conducted. This cross-sectional study aimed to evaluate the methodological quality and predictors among SRs on osteoarthritis interventions. Methods: Four electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, and PsycINFO) were searched, from 1 January 2008 to 10 October 2019. An SR was eligible if it focused on osteoarthritis interventions, and we performed at least one meta-analysis. Methodological quality was assessed using the validated AMSTAR 2 instrument. Multivariate regression analyses were conducted to assess predictors of methodological quality. Results: In total, 167 SRs were included. The most SRs were non-Cochrane reviews (88.6%), and 54.5% investigated non-pharmacological interventions. Only seven (4.2%) had high methodological quality. Respectively, eight (4.8%), 25 (15.0%), and 127 (76.0%) SRs had moderate, low, and critically low quality. Main methodological weaknesses were as follows: only 16.8% registered protocol a priori, 4.2% searched literature comprehensively, 25.7% included lists of excluded studies with justifications, and 30.5% assessed risk of bias appropriately by considering allocation concealment, blinding of patients and assessors, random sequence generation and selective reported outcomes. Cochrane reviews [adjusted odds ratio (AOR) 251.5, 95% confidence interval (CI) 35.5–1782.6], being updates of previous SRs (AOR 3.9, 95% CI 1.1–13.7), and SRs published after 2017 (AOR 7.7, 95% CI 2.8–21.5) were positively related to higher methodological quality. Conclusion: Despite signs of improvement in recent years, most of the SRs on osteoarthritis interventions have critically low methodological quality, especially among non-Cochrane reviews. Future SRs should be improved by conducting comprehensive literature search, justifying excluded studies, publishing a protocol, and assessing the risk of bias of included studies appropriately.

scholarly journals The effectiveness of digital technology interventions to reduce loneliness in adult people: A protocol for a systematic review and meta-analysis

2019 ◽  
Author(s):  
Syed Ghulam Sarwar Shah ◽  
David Nogueras ◽  
Hugo Cornelis van Woerden ◽  
Vasiliki Kiparoglou
Keyword(s):  
Public Health ◽  
Systematic Review ◽  
Digital Technology ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
List Type ◽  
Quality Of Evidence ◽  
Randomized Studies ◽  
Health And Social Care

ABSTRACTIntroductionLoneliness is an emerging public health problem, which is associated with social, emotional, mental and physical health issues. The application of digital technology (DT) interventions to reduce loneliness has increased in recent years. The effectiveness of DT interventions needs to be assessed systematically.Methods and analysisAimTo undertake a systematic review and meta-analysis on the effectiveness of digital technology interventions to reduce loneliness among adult people.Designsystematic review and meta-analysis.Data sourcesFive leading online bibliographic databases: PubMed, Medline, CINAHL, EMBASE, and Web of Science.Publication period1 January 2010 to 30 April 2019.Inclusion criteriaPrimary studies involving the application of digital technology interventions to reduce loneliness, involving adult participants (aged 18 years and more) and published in the English language.Search strategyLiterature searches using a priory list of keywords, involvement of two independent researchers in article screening, short listing and data extraction using a predefined template based on the population, intervention(s), comparator(s) and outcome(s) (PICO) framework.Synthesis and meta-analysisA narrative summary of the characteristics of included studies, findings by the type of DT intervention, and the age, gender and ethnicity of participants. A meta-analysis by the type of DT intervention and determination of effect sizes.Quality of evidence and biasQuality of evidence assessed the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and ROBINS-I (Risk Of Bias in Non-randomized Studies - of Interventions) tools for randomized control trials and non-randomized studies respectively. Heterogeneity between studies determined by the I2 and Cochran’s Q statistics and publication bias checked with funnel plots and the Egger’s test.Patients and public involvementNoneEthics and disseminationEthics approval was not required for writing this protocol. The findings will be disseminated through the publication of research articles and conference presentations.PROSPERO Registration NumberCRD42019131524.Article SummaryStrengths and limitations of this studyThe main strength of this study includes a systematic assessment of evidence on the effectiveness of digital technology interventions to reduce loneliness, which is imperative from the health and social care and public health perspectives.Another strength of the study is the involvement of two independent researchers (and a third researcher as an arbitrator) involved in the identification, screening, inclusion and extraction of on a predefined template using the PICO framework.Limitations may include missing identification of additional relevant studies due to the application of selection filters such as the publication years and English as the publication language.

scholarly journals Peer support for smoking cessation: a protocol of systematic review and meta-analysis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyun-Ju Seo ◽  
Soo Young Kim ◽  
Dongah Park ◽  
Seung-Soo Sheen ◽  
Miyoung Choi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Peer Support ◽  
Meta Analysis ◽  
Healthcare Providers ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quit Smoking ◽  
Quantitative Synthesis

Abstract Background Peer-support programs are a useful social support strategy for populations trying to quit smoking who are willing to maintain smoking abstinence. This study is a protocol for a systematic review and meta-analysis to assess the effectiveness of peer support for smoking cessation. Methods This protocol will be conducted in accordance with the Cochrane Handbook of Systematic Reviews of Interventions 6.2. We will conduct a comprehensive search in the Cochrane Central Register of Controlled Trials, ovidEmbase, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, ovidMEDLINE, Google Scholar, and Open Grey, as well as the Trials Register of Promoting Health Interventions in EPPI-Centre, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and reference lists of included papers. The review will include randomized controlled trials of peer support interventions aimed to stop smoking in any population. Two reviewers will independently screen and select relevant studies. Version 2 of the Cochrane tool that assesses risk of bias in randomized trials will be used to assess the risk of bias in the included studies. The primary outcomes will be defined as the tobacco abstinence rate and adverse events. If a quantitative synthesis is not appropriate, a synthesis without meta-analysis will be undertaken. Discussion This review will provide the best available evidence regarding the effects of peer support interventions to quit smoking. The results from this study will help to inform healthcare providers on the optimal peer support intervention modalities such as intensity, delivery methods, type of support provider, and duration of the intervention. Systematic review registration PROSPERO CRD42020196288

A systematic review and meta-analysis on efficacy of exercise on posture and balance in patients suffering from Diabetic Neuropathy

2020 ◽  
Vol 16 ◽  
Author(s):  
Neerja Thukral ◽  
Jaspreet Kaur ◽  
Manoj Malik
Keyword(s):  
Diabetes Mellitus ◽  
Diabetic Neuropathy ◽  
Meta Analysis ◽  
Berg Balance Scale ◽  
Risk Of Bias ◽  
Core Stability ◽  
Balance Scale ◽  
Eyes Closed ◽  
Significant Difference ◽  
Eyes Open

Background: Peripheral neuropathy is a major and chronic complication of diabetes mellitus affecting more than 50% of patients suffering from diabetes. There is involvement of both large and small diameter nerve fibres leading to altered somatosensory and motor sensations, thereby causing impaired balance and postural instability. Objective: To assess the effects of exercises on posture and balance in patients suffering from diabetes mellitus. Method: Mean changes in Timed Up and Go test(TUGT), Berg Balance Scale and Postural Sway with eyes open and eyes closed on Balance System were primary outcome measures. RevMan 5.3 software was used for the meta-analyses. Eighteen randomized controlled trials met the selection criteria and were included in the study. All the studies ranked high on PEDro Rating scale. Risk of bias was assessed by Cochrane collaboration tool of risk of bias. Included studies had low risk of bias. Sixteen RCT’s were included for the meta-analysis. Result: Results of meta-analysis showed that there was statistically significant improvement in TUGT with p≤ 0.05 and substantial heterogeneity (I 2 = 84%, p < 0.00001) in experimental group as compared to control group. There was statistically significant difference in Berg Balance Scale scores and heterogeneity of I 2 = 62%, p < 0.00001 and significant changes in postural stability (eyes open heterogeneity of I 2 = 100%, p =0.01 and eyes closed, heteogeneity I 2 = 0%, p =0.01). Sensitivity analysis causes change in heterogeneity. Conclusion: It can be concluded that various exercises like balance training, core stability, Tai-Chi, proprioceptive training etc. have a significant effect in improving balance and posture in diabetic neuropathy.

Web-based interventions aimed at improving the mental health effects of home caregivers for dementia: Meta-analysis (Preprint)

2019 ◽  
Author(s):  
Hui Feng ◽  
Yinan Zhao ◽  
Mingyue Hu ◽  
Hengyu Hu ◽  
Hui Li ◽  
...  
Keyword(s):  
Mental Health ◽  
Meta Analysis ◽  
The Elderly ◽  
Anxiety Symptoms ◽  
Average Score ◽  
Physical And Mental Health ◽  
Web Based ◽  
Negative Results ◽  
Cochrane Database ◽  
The Web

BACKGROUND Dementia is one of the major cause of disability and dependency among the elderly worldwide, and there are general psychological distresses among caregivers in dementia, such as depression and anxiety symptoms. The physical and mental health of the caregiver is a prerequisite and a promise to help the elderly stay alive and promote health. Web-based interventions can provide for a more convenient and efficient support and education, OBJECTIVE The purpose of this study was to examine the effect of internet-based interventions on mental health outcomes of family caregivers with dementia, and exploring which components of the web-based interventions play an important role.which are likely to reduce caregivers’ negative outcomes associated with care. METHODS A comprehensive literature search was conducted on PubMed, Embase, PsycINFO, Cochrane Database and CINAHL by using relevant terms such as web-based and caregiver as keywords, covering all studies published before June 2018. Two reviewers independently reviewed all published abstracts, according to the established inclusion and exclusion criteria ，we extracted the information about participants, interventions and results, respectively, and reviewed the quality of articles on the methods of randomized trials using the approach recommended by the Cochrane Handbook for systematic review for intervention. RESULTS A total of 815 caregivers participated in 6 articles, and 4 of the studies use depression as an outcome, according to the research after different interventions based on network after the intervention, depression scores average drop of 0.23 (95%CI -0.38 to -0.07, p<0.01), 2 studies show caregivers anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI -0.50 to -0.14, p< 0.01), but in terms of coping, pain and stress, the web-based interventions have shown a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve mental health of carers. CONCLUSIONS Internet-based interventions were generally effective in reducing anxiety and depression in dementia carers, although negative results were found in some studies. But in terms of burden and stress, further research is needed.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Dose–Response Relation between Tea Consumption and Risk of Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis of Population-Based Studies

2020 ◽  
Vol 11 (4) ◽  
pp. 790-814 ◽  
Author(s):  
Mei Chung ◽  
Naisi Zhao ◽  
Deena Wang ◽  
Marissa Shams-White ◽  
Micaela Karlsen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Studies ◽  
Prospective Cohort ◽  
Lower Risk ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Tea Consumption ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Cvd Mortality

ABSTRACT Tea flavonoids have been suggested to offer potential benefits to cardiovascular health. This review synthesized the evidence on the relation between tea consumption and risks of cardiovascular disease (CVD) and all-cause mortality among generally healthy adults. PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Food Science and Technology Abstracts, and Ovid CAB Abstract databases were searched to identify English-language publications through 1 November 2019, including randomized trials, prospective cohort studies, and nested case-control (or case-cohort) studies with data on tea consumption and risk of incident cardiovascular events (cardiac or peripheral vascular events), stroke events (including mortality), CVD-specific mortality, or all-cause mortality. Data from 39 prospective cohort publications were synthesized. Linear meta-regression showed that each cup (236.6 mL)  increase in daily tea consumption (estimated 280 mg  and 338 mg  total flavonoids/d for black and green tea, respectively) was associated with an average 4% lower risk of CVD mortality, a 2% lower risk of CVD events, a 4% lower risk of stroke, and a 1.5% lower risk of all-cause mortality. Subgroup meta-analysis results showed that the magnitude of association was larger in elderly individuals for both CVD mortality (n = 4; pooled adjusted RR: 0.89; 95% CI: 0.83, 0.96; P = 0.001), with large heterogeneity (I2 = 72.4%), and all-cause mortality (n = 3; pooled adjusted RR: 0.92; 95% CI: 0.90, 0.94; P &lt; 0.0001; I2 = 0.3%). Generally, studies with higher risk of bias appeared to show larger magnitudes of associations than studies with lower risk of bias. Strength of evidence was rated as low and moderate (depending on study population age group) for CVD-specific mortality outcome and was rated as low for CVD events, stroke, and all-cause mortality outcomes. Daily tea intake as part of a healthy habitual dietary pattern may be associated with lower risks of CVD and all-cause mortality among adults.

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