scholarly journals HÁBITOS DE FUMO COMO COMPONENTES DA AVALIAÇÃO PARA RISCO CARDIOVASCULAR ENTRE RIBEIRINHOS: UM ESTUDO DE REVISÃO SISTEMÁTICA COM METANÁLISE

2021 ◽  
Author(s):  
Maria do Espírito Santo Batista Guedes ◽  
Zilmar Augusto De Souza Filho
Keyword(s):  
Systematic Reviews ◽  
Observational Studies ◽  
Check List ◽  
Meta Analyses

Introdução: O tabagismo é um importante fator de risco cardiovascular que está presente nos hábitos e estilo de vida dos ribeirinhos. As especificidades vivenciadas por estas populações relacionadas às dificuldades de acesso aos serviços de saúde dificultam o acompanhamento e o tratamento de saúde de forma regular e contínua. Objetivo: Investigar nos estudos transversais a prevalência do tabagismo entre as populações ribeirinhas. Método: Revisão sistemática com metanálise com pesquisas realizadas nas bases de dados PubMed, Biblioteca Virtual em Saúde, Scielo, Portal de Periódico Capes e Repositório de Teses de Dissertações da Universidade Federal do Amazonas. Os termos foram extraídos dos Descritores em Ciências da Saúde combinados por meio dos operadores booleanos OR e AND. Não houve restrição de data, tamanho da amostra e idiomas. Das 68 referências encontradas, 13 artigos atenderam aos critérios de elegibilidade. Na seleção dos artigos foi aplicado o check-list do Strengthening the Reportingof Observational studies in Epidemiology e utilizada a recomendação do Preferred Reporting Items for Systematic Reviews and Meta-Analyses, como guia para a revisão sistemática. A metanálise e o florest plot foram processados utilizando o software estatístico Stata, versão 13.0. Resultados: A prevalência de tabagismo entre os ribeirinhos variou de 11,1% a 54,7% com uma síntese através da meta-análise de 38% de risco de virem a ser tabagistas, (RR=1,38 IC95% 1,34 – 1,42). Conclusão: A partir dos índices de prevalência do tabagismo, conclui-se que houve diferença estatisticamente significativa nas estimativas do risco relativo nos diferentes anos incluídos na metanálise, favorecendo o fator de risco em comparação com o fator de proteção. A estimativa infere sobre a necessidade de monitoramento e rastreio da extensão do problema a fim de implementar intervenções de prevenção, diagnóstico e tratamento, visando reduzir a incidência de doenças cardiovasculares entre as populações ribeirinhas.

scholarly journals COSMOS-E: Guidance on conducting systematic reviews and meta-analyses of observational studies of etiology

PLoS Medicine ◽  
2019 ◽  
Vol 16 (2) ◽  
pp. e1002742 ◽  
Author(s):  
Olaf M. Dekkers ◽  
Jan P. Vandenbroucke ◽  
Myriam Cevallos ◽  
Andrew G. Renehan ◽  
Douglas G. Altman ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Observational Studies ◽  
Meta Analyses

scholarly journals Dietary Carbohydrate and Diverse Health Outcomes: Umbrella Review of 30 Systematic Reviews and Meta-Analyses of 281 Observational Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
Ya-Shu Liu ◽  
Qi-Jun Wu ◽  
Jia-Le Lv ◽  
Yu-Ting Jiang ◽  
Hui Sun ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Carbohydrate Intake ◽  
Dietary Carbohydrate ◽  
Umbrella Review ◽  
Suggestive Evidence ◽  
All Cause Mortality ◽  
Meta Analyses

Background and Aims: The associations between dietary carbohydrate and diverse health outcomes remain controversial and confusing. To summarize the existing evidence of the association between dietary carbohydrate intake and diverse health outcomes and to evaluate the credibility of these sources of evidence. We performed this umbrella review of evidence from meta-analyses of observational studies.Methods: PubMed, Embase, Web of Science databases, and manual screening of references up to July 2020 were searched. Systematic reviews with meta-analyses of observational studies in humans investigating the association between dietary carbohydrate intake and multiple health outcomes were identified. We assessed the evidence levels by using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis.Results: We included 43 meta-analyses of observational research studies with 23 health outcomes, including cancer (n = 26), mortality (n = 4), metabolic diseases (n = 4), digestive system outcomes (n = 3), and other outcomes [coronary heart disease (n = 2), stroke (n = 1), Parkinson's disease (n = 1), and bone fracture (n = 2)]. This umbrella review summarized 281 individual studies with 13,164,365 participants. Highly suggestive evidence of an association between dietary carbohydrate intake and metabolic syndrome was observed with adjusted summary odds ratio of 1.25 [95% confidence interval (CI) 1.15–1.37]. The suggestive evidences were observed in associations of carbohydrate consumption with esophageal adenocarcinoma (0.57, 95% CI = 0.42–0.78) and all-cause mortality (adjusted summary hazard ratio 1.19, 95% CI = 1.09–1.30).Conclusions: Despite the fact that numerous systematic reviews and meta-analyses have explored the relationship between carbohydrate intake and diverse health outcomes, there is no convincing evidence of a clear role of carbohydrate intake. However, there is highly suggestive evidence suggested carbohydrate intake is associated with high risk of metabolic syndrome, suggestive evidence found its association with increased risk of all-cause mortality and decreased risk of esophageal adenocarcinoma.Systematic Review Registration: CRD42020197424.

scholarly journals Neutrophil counts and cancer prognosis: an umbrella review of systematic reviews and meta-analyses of observational studies

2018 ◽  
Author(s):  
Meghan A. Cupp ◽  
Margarita Cariolou ◽  
Ioanna Tzoulaki ◽  
Evangelou Evangelos ◽  
Antonio J. Berlanga-Taylor
Keyword(s):  
Systematic Reviews ◽  
Strong Evidence ◽  
Observational Studies ◽  
Cancer Prognosis ◽  
Small Study ◽  
List Type ◽  
Cancer Outcomes ◽  
Umbrella Review ◽  
Eligibility Criteria ◽  
Meta Analyses

ABSTRACTOBJECTIVETo evaluate the strength and validity of evidence on the association between the neutrophil to lymphocyte ratio (NLR) or tumour-associated neutrophils (TAN) and cancer prognosis.DESIGNUmbrella review of systematic reviews and meta-analyses of observational studies.DATA SOURCESMedline, EMBASE, and Cochrane Database of Systematic Reviews.ELIGIBILITY CRITERIASystematic reviews or meta-analyses of observational studies evaluating the association between NLR or TAN and specific cancer outcomes related to disease progression or survival.DATA SYNTHESISThe available evidence was graded as strong, highly suggestive, suggestive, or weak through the application of pre-set grading criteria. For each included meta-analysis, the grading criteria considered the significance of the random effects estimate, the significance of the largest included study, the number of studies and individuals included, the heterogeneity between included studies, the 95% prediction intervals, presence of small study effects, excess significance and credibility ceilings.RESULTS239 meta-analyses investigating the association between NLR or TAN and cancer outcomes were identified from 57 published studies meeting the eligibility criteria, with 81 meta-analyses from 36 studies meeting the criteria for inclusion. No meta-analyses found a hazard ratio (HR) in the opposite direction of effect (HR<1). When assessed for significance and bias related to heterogeneity and small study effects, only three (4%) associations between NLR and outcomes in gastrointestinal and nasopharyngeal cancers were supported by strong evidence.CONCLUSIONDespite many publications exploring the association between NLR and cancer prognosis, the evidence is limited by significant heterogeneity and small study effects. There is a lack of evidence on the association between TAN and cancer prognosis, with all nine associations identified arising from the same study. Further research is required to provide strong evidence for associations between both TAN and NLR and poor cancer prognosis.REGISTRATIONThis umbrella review is registered on PROSPERO (CRD42017069131)FUNDINGMedical Research CouncilCOPYRIGHTOpen access article under terms of CC BYSHORT TITLENeutrophils and cancer prognosis: an umbrella reviewKEY RESULTWhen assessed for significance and bias related to heterogeneity and small study effects, only three (4%) associations between NLR and overall survival and progression-free survival in gastrointestinal and nasopharyngeal cancers were supported by strong evidence.WHAT THIS PAPER ADDSWHAT IS ALREADY KNOWN ON THE TOPICNeutrophil counts have been linked to the progression of cancer due to their tumourigenic role in the cancer microenvironment.Numerous meta-analyses and individual studies have explored the association between neutrophil counts and cancer outcomes for a variety of cancer sites, leading to a large body of evidence with variable strength and validity.Uncertainty exists around the association between neutrophils and cancer outcomes, depending on the site, outcome and treatments considered.WHAT THIS STUDY ADDSAll meta-analyses included in this review indicated an association between high neutrophil counts and poor cancer prognosis.There is strong evidence supporting the association between the neutrophil to lymphocyte ratio and poor cancer prognosis in some respiratory and gastrointestinal cancers.Further research is required to strengthen the existing body of evidence, particularly for the association between tumour-associated neutrophils and cancer outcomes.

scholarly journals Evidence-Based Medicine, Systematic Reviews, and Guidelines in Interventional Pain Management: Part 6. Systematic Reviews and Meta-Analyses of Observational Studies

2008 ◽  
Vol 5;12 (5;9) ◽  
pp. 819-850
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Evidence Based Medicine ◽  
Observational Studies ◽  
Meta Analysis ◽  
Evidence Based ◽  
Confounding Bias ◽  
Meta Analyses ◽  
Based Medicine

Observational studies provide an important source of information when randomized controlled trials (RCTs) cannot or should not be undertaken, provided that the data are analyzed and interpreted with special attention to bias. Evidence-based medicine (EBM) stresses the examination of evidence from clinical research and describes it as a shift in medical paradigm, in contrast to intuition, unsystematic clinical experience, and pathophysiologic rationale. While the importance of randomized trials has been created by the concept of the hierarchy of evidence in guiding therapy, much of the medical research is observational. The reporting of observational research is often not detailed and clear enough with insufficient quality and poor reporting, which hampers the assessment of strengths and weaknesses of the study and the generalizability of the mixed results. Thus, in recent years, progress and innovations in health care are measured by systematic reviews and meta-analyses. A systematic review is defined as, “the application of scientific strategies that limit bias by the systematic assembly, clinical appraisal, and synthesis of all relevant studies on a specific topic.” Meta-analysis usually is the final step in a systematic review. Systematic reviews and meta-analyses are labor intensive, requiring expertise in both the subject matter and review methodology, and also must follow the rules of EBM which suggests that a formal set of rules must complement medical training and common sense for clinicians to integrate the results of clinical research effectively. While expertise in the review methods is important, the expertise in the subject matter and technical components is also crucial. Even though, systematic reviews and meta-analyses, specifically of RCTs, have exploded, the quality of the systematic reviews is highly variable and consequently, the opinions reached of the same studies are quite divergent. Numerous deficiencies have been described in methodologic assessment of the quality of the individual articles. Consequently, observational studies can provide an important complementary source of information, provided that the data are analyzed and interpreted in the context of confounding bias to which they are prone. Appropriate systematic reviews of observational studies, in conjunction with RCTs, may provide the basis for elimination of a dangerous discrepancy between the experts and the evidence. Steps in conducting systematic reviews of observational studies include planning, conducting, reporting, and disseminating the results. MOOSE, or Meta-analysis of Observational Studies in Epidemiology, a proposal for reporting contains specifications including background, search strategy, methods, results, discussion, and conclusion. Use of the MOOSE checklist should improve the usefulness of meta-analysis for authors, reviewers, editors, readers, and decision-makers. This manuscript describes systematic reviews and meta-analyses of observational studies. Authors frequently utilize RCTs and observational studies in one systematic review; thus, they should also follow the reporting standards of the Quality of Reporting of Meta-analysis (QUOROM) statement, which also provides a checklist. A combined approach of QUOROM and MOOSE will improve reporting of systematic reviews and lead to progress and innovations in health care. Key words: Observational studies, evidence-based medicine, systematic reviews, metaanalysis, randomized trials, case-control studies, cross-sectional studies, cohort studies, confounding bias, QUOROM, MOOSE

scholarly journals Effect of Conventional Chemotherapy in Patients With Neuroendocrine Tumours: A Systematic Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A1015-A1016
Author(s):  
Anida Divanovic ◽  
Maralyn Rose Druce
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Observational Studies ◽  
Neuroendocrine Tumours ◽  
Chemotherapeutic Agents ◽  
Neuroendocrine Cells ◽  
Cochrane Library ◽  
Safety And Efficacy ◽  
Grade 3 ◽  
Meta Analyses

Abstract Background: Neuroendocrine tumours (NETs) are a wide-ranging group of neoplasms originating from neuroendocrine cells. In 2014 NETs incidence was 7 per 100000 people annually. The purpose of this systematic review is to evaluate the safety and efficacy of various types of chemotherapeutic agents on gastroenteropancreatic NETs (GEP NETs) and to determine which type of chemotherapy is the most effective for different tumour types, with minimum adverse events. To our knowledge, this study is the first systematic review that compares several types of chemotherapy and evaluates their safety and efficacy on GEP NETs. Methods: The study followed recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on reporting systematic reviews. The literature search for this systematic review was conducted using the following databases and search engines: Cochrane library, EMBASE, Google Scholar, PubMed, and Web of Science, from 1963 to 2020. Results: The review comprised 26 observational studies, and 5 randomized controlled trials (RCTs). The total number of subjects included in this study was 1783. Our study showed that the most effective treatment for Grade 3 NETs and Grade 3 neuroendocrine carcinomas was cisplatin/etoposide. Furthermore, capecitabin/temozolomide therapy has been shown to be most effective in Grade 1 and Grade 2 NETs. Conclusion: Therapy with two chemotherapeutic agents has been shown to be more effective than monotherapy and therapy with three chemotherapeutic agents. Unfortunately, our study has limitations and we urgently need RCTs or larger observational studies that will contain all the necessary efficacy and safety tools, and thus provide answers to our clinical questions.

scholarly journals Systematic Differences in Effect Estimates Between Observational Studies and Randomized Control Trials in Meta-Analyses Combining Both Study Designs in Nephrology

2020 ◽  
Author(s):  
Miho Kimachi ◽  
Akira Onishi ◽  
Aran Tajika ◽  
Kimihiko Kimachi ◽  
Toshi Furukawa
Keyword(s):  
Systematic Reviews ◽  
Observational Studies ◽  
Statistical Significance ◽  
Randomized Control Trials ◽  
Causal Inferences ◽  
Randomized Controlled ◽  
The Past ◽  
Randomized Control ◽  
Meta Analyses ◽  
Study Designs

Abstract The limited availability of randomized controlled trials (RCTs) in nephrology undermines causal inferences in meta-analyses. Systematic reviews of observational studies have grown more common under such circumstances. We conducted systematic reviews of all comparative observational studies in nephrology from 2006 to 2016 to assess the trends in the past decade. We then focused on the meta-analyses combining observational studies and RCTs to evaluate the systematic differences in effect estimates between study designs using two statistical methods: by estimating the ratio of odds ratios (ROR) of the pooled OR obtained from observational studies versus those from RCTs and by examining the discrepancies in their statistical significance. The number of systematic reviews of observational studies in nephrology had grown by 11.7-fold in the past decade. Among 56 records combining observational studies and RCTs, ROR suggested that the estimates between study designs agreed well (ROR: 1.05, 95% confidence interval: 0.90-1.23). However, almost half of the reviews led to discrepant interpretations in terms of statistical significance. In conclusion, the findings based on ROR might encourage researchers to justify the inclusion of observational studies in meta-analyses. However, caution is needed as the interpretations based on statistical significance were less concordant than those based on ROR.

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