Objective:Heterogeneity in the evidence of association between lifestyle factors and breast cancer(BC)incidence hampers initiatives to modify BC risk.This overview aims to synthesise evidence from systematic reviews(S...Objective:Heterogeneity in the evidence of association between lifestyle factors and breast cancer(BC)incidence hampers initiatives to modify BC risk.This overview aims to synthesise evidence from systematic reviews(SRs)to inform lifestyle-related modifications for BC prevention.Methods:We systematically searched(MEDLINE,EMBASE,and CINAHL)from January 2013 to August 2023 for SRs of the association between lifestyle factors[alcohol consumption,physical activity(PA),body mass index(BMI),smoking,breastfeeding,oral contraception(OC),hormone replacement therapy(HRT),and sedentary behavior(SB)]and BC incidence.A narrative data synthesis was performed.Results:Sixty-six SRs met the eligibility criteria.Evidence from 40 SRs indicated consistent associations between the risk of BC and postmenopausal BMI increase(relative risk increase:2%-21%),use of HRT(risk increase:23%-33%),smoking(risk increase:4%-86%),and alcohol consumption(risk increase:4%-61%).Additionally,evidence from 23 SRs suggested protective associations with PA(risk decrease:10%-39%),breastfeeding(risk decrease:9%-53%),and healthy lifestyle scores(protective about 20%-26%).However,inconsistent and/or statistically non-significant associations were found between BC incidence and premenopausal BMI increase[relative risk(RR):0.78-1.08],SB(RR:1.01-1.20),and OC use[odds ratio(OR):1.01-1.35].Conclusions:This overview identifies lifestyle factors associated with BC incidence,highlighting both harmful and protective factors.Our summary findings can support information and interventions related to modifying these factors,including limiting alcohol and smoking,or avoiding postmenopausal BMI increase and HRT.展开更多
Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clini...Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.展开更多
Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs wer...Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.展开更多
BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological...BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological information in the included papers can often be lacking or unclear,and reviewers usually need to contact the authors of included studies for clarifications.Contacting authors is recommended,but it is unclear how often SR teams do it,or what the level of response is.AIM To investigate how often reviewers undertake contact with the authors of included randomized controlled trials(RCTs)for clarification on data and risk of bias concerns,to explore the factors that influence whether SR authors contact or do not contact the authors,and the content and level of responses.METHODS We conducted a systematic electronic database search in MEDLINE using the search string“(systematic review)”AND“(RCT OR randomized OR trial)”for articles published between 1 January 2024 and 19 February 2024,without language restrictions.Screening and data extraction was done independently by two reviewers,and conflicts resolved by a senior author.Contact authors of included SRs were contacted for clarifications.RESULTS Of the 329 included SRs,38%(n=125)explicitly mentioned contact with the authors of included studies.The remaining 62%(n=204)did not.We attempted contact with all SR teams for clarifications and received 90 responses(19.4%).Of the 50 respondents who did not explicitly mention contact in their SRs,25(50%)replied that they did make contact.We received a total of 64 responses on the level and content of information sought.The mean±SD contacts SR teams made were 10(10),replies received 5(6.7),and response waiting time 10.1(28.3)weeks.Resources,time,poor previous experience,perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.CONCLUSION The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors.However,SR teams reported that 50%of contacted primary authors respond.Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.展开更多
Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Metho...Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.展开更多
OBJECTIVE:To evaluate and summarise the evidence from published Meta-analyses/systematic reviews(MAs/SRs)of Traditional Chinese Medicine(TCM)in the treatment of recurrent respiratory tract infections(RRTIs)and to prov...OBJECTIVE:To evaluate and summarise the evidence from published Meta-analyses/systematic reviews(MAs/SRs)of Traditional Chinese Medicine(TCM)in the treatment of recurrent respiratory tract infections(RRTIs)and to provide a scientific basis for the clinical treatment of RRTIs with TCM.METHODS:Studies were retrieved from Chinese and English databases including the China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,SinoM ed,PubM ed,Web of Science,the Cochrane Library and EMbase from their establishment date to March 2023.Involved studies were screened,extracted,and evaluated for quality by two researchers independently.The a measurement tool to assess systematic reviews(AMSTAR)2 scale was used for methodological quality evaluation,as well as the preferred reporting items for systematic reviews and Meta-analyses(PRISMA)2020 statement for report quality evaluation,the risk of bias in systematic reviews(ROBIS)tool for risk of bias,and the grading of recommendations,assessment,development and evaluation(GRADE)quality assessment tool for evidence quality.RESULTS:Twenty MAs/SRs studies were included,including analyses of 274 original studies involving 38335 patients with RRTIs.The AMSTAR 2 scale evaluation results showed that 19 studies were of very low quality and one of moderate quality.The ROBIS evaluation results showed that 11 MAs/SRs were at high risk and nine at low risk of bias.The PRISMA 2020 report quality showed the included studies had scores between 23.5 and 35.5,among them one with high quality,17 with moderate quality and two with low quality.The GRADE system results showed that among 126 outcome indicators,only 17 had moderate quality of evidence,27 had low quality,82 had very low quality,and none had high quality.CONCLUSIONS:The MAs/SRs methodological quality of using TCM for treatment RRTIs is generally poor,the quality of reports as well as of evidence is generally low,and the risk of bias is high;therefore we should treat these results with caution.展开更多
This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for male infertility and assess the quality of evidence and possible biases.An umbrella review of sys...This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for male infertility and assess the quality of evidence and possible biases.An umbrella review of systematic reviews and meta-analyses available in PubMed,Web of Science,and Scopus,covering studies published up to October 2023,was conducted.Sperm concentration,morphology,and motility were used as endpoints to evaluate the effectiveness of the treatments.Of 2998 studies,18 published meta-analyses were extracted,yielding 90 summary effects on sperm concentration(n=36),sperm morphology(n=26),and sperm motility(n=28)on 28 interventions.None of the meta-analyses were classified as having low methodological quality,whereas 12(66.7%)and 6(33.3%)had high and moderate quality,respectively.Of the 90 summary effects,none were rated high-evidence quality,whereas 53.3%(n=48),25.6%(n=23),and 21.1%(n=19)were rated moderate,low,and very low,respectively.Significant improvements in sperm concentration,morphology,and motility were observed with pharmacological interventions(N-acetyl-cysteine,antioxidant therapy,aromatase inhibitors,selective estrogen receptor modulators,hormones,supplements,and alpha-lipoic acid)and nonpharmacological interventions(varicocele repair and redo varicocelectomy).In addition,vitamin supplementation had no significant positive effects on sperm concentration,motility,or morphology.Treatments for male infertility are increasingly diverse;however,the current evidence is poor because of the limited number of patients.Further well-designed studies on single treatment and high-quality meta-analysis of intertreatment comparisons are recommended.展开更多
Objective:To assess the reliability of the methodological quality and outcome measures of systematic reviews(SR)/meta-analysis of premature ovarian insufficiency(POI) treated with acupuncture.Methods:SR/meta-analysis ...Objective:To assess the reliability of the methodological quality and outcome measures of systematic reviews(SR)/meta-analysis of premature ovarian insufficiency(POI) treated with acupuncture.Methods:SR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed,Web of Science,EMBase,the Cochran Library,Chinese biomedical literature database(SinoMed),China journal full-text database(CNKI),Wanfang data knowledge service platform(Wanfang)and VIP information Chinese periodical service platform(VIP),from inception to 1 st May 2021.Using A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2) scale and Grades of Recommendations Assessment,Development and Evaluation(GRADE) system,the methodological quality and outcome measures of the included studies were appraised.Results:Ten articles of SR/meta-analysis were included,published from 2015 to 2020.Using AMSTAR 2,5 articles of SR/meta-analysis were rated as critical low quality in methods,3 articles as low quality,and2 articles as moderate quality.The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low,that of 25 outcomes was low and that of 3 outcomes was moderate.Conclusion:The methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture,which may affect the translation of the SR/metaanalysis findings into clinical practice.It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis,as well as the robustness of design and implementation of randomized controlled trials(RCTs),in order to generate high quality evidences for clinical decision-making and practice.展开更多
Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture ...Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.展开更多
Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accura...Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.展开更多
This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinica...This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.展开更多
Objective: To overview the systematic reviews of acupuncture for Post-stroke Dysphagia. Methods: The Chinese and English databases were searched for the systematic reviews of dysphagia after acupuncture treatment. The...Objective: To overview the systematic reviews of acupuncture for Post-stroke Dysphagia. Methods: The Chinese and English databases were searched for the systematic reviews of dysphagia after acupuncture treatment. The retrieval time was until October 30, 2019. The final literature was evaluated for bias risk, methodology quality and evidence quality by using ROBIS tool, AMSTER-2 scale and GRADE method. Results: 9 systematic reviews and 36 outcomes were included. ROBIS bias risk assessment results show that all the studies are high bias risk;AMSTER-2 methodology quality assessment results show that all the systems are of very low quality;GRADE grading shows that there are only 7 intermediate evidences in 36 clinical evidences, the rest are low-level evidences or very low-level evidences, and there are multiple intermediate evidences in the clinical efficacy of acupuncture in the treatment of dysphagia after stroke. In addition, acupuncture can significantly improve the scores of all kinds of swallowing function related scales, such as Tengdao food intake swallowing function grade, swallowing disorder specific quality of life score, standard swallowing function evaluation scale, and the incidence of adverse reactions is low. Conclusion: Acupuncture is effective in the treatment of dysphagia after stroke. It can improve the scores of various swallowing function scales and has high safety. However, the risk of systematic evaluation bias is high, the quality of methodology is low, and the level of clinical evidence is low as a whole. In the future, the relevant research design should be more rigorous, and the research report should be written in strict accordance with the PRISMA statement.展开更多
Background and aim： Several systematic reviews and meta-analyses published within the past years have examined the associations of Mediterranean-style diets （MedSDs） on cognitive. However, these reviews have not be...Background and aim： Several systematic reviews and meta-analyses published within the past years have examined the associations of Mediterranean-style diets （MedSDs） on cognitive. However, these reviews have not been evaluated for satisfying Contemporary methodologies quality standards. At the same time, due to the high demand for related care during the aging process in China, it is necessary to summarize the ex-isting system evaluation and evaluate the quality of it, so as to provide strong evidence for the development of relevant work and to standardize the research process and methods in this field. This study evaluated the quality of recent systematic reviews and meta-analyses on MedSD and cognitive outcomes by using an established methodology quality scale, and to provide some valuable references for future research and Chinese systematic review and meta-analysis developing. Methods： We used the AMSTAR Methodology Quality Assessment Scale to evaluate the quality of methodology of the existing meta-analyses and systematic review. Meta analysis and systematic review that meets our criteria must contain the following characteristics： 1） used systematic or meta-analytic procedures to review the lit-erature, and 2） had MedSD interventions independently. Results： Reviews satisfied with 5 to 9 of the AMSTAR MedSD items （mean 7.35, standard deviation： 1.27）, quality is above average with those published in higher-impact journals having a greater quality score. Conclusion： These data suggest that current meta-analyses/systematic reviews evaluating the effect of MedSD on cognitive do not fully meet contemporary methodology quality standards. The methodological quality of the literature needs to be im- proved. As a result, there are more research questions to answer to enhance our understanding of how MedSD affects cognitive. To clarify associations between MedSD and cognitive, future meta-analyses and systematic reviews should not only follow methodology quality standards but also include more statistical modeling results when data allow. And in order to make the conclusions more reliable, we expect higher quality RCTs in the future.展开更多
Objectives:The aim of this study was to investigate and develop a data storage and exchange format for the process of automatic systematic reviews(ASR)of traditional Chinese medicine(TCM).Methods:A lightweight and com...Objectives:The aim of this study was to investigate and develop a data storage and exchange format for the process of automatic systematic reviews(ASR)of traditional Chinese medicine(TCM).Methods:A lightweight and commonly used data format,namely,JavaScript Object Notation(JSON),was introduced in this study.We designed a fully described data structure to collect TCM clinical trial information based on the JSON syntax.Results:A smart and powerful data format,JSON-ASR,was developed.JSON-ASR uses a plain-text data format in the form of key/value pairs and consists of six sections and more than 80 preset pairs.JSON-ASR adopts extensible structured arrays to support the situations of multi-groups and multi-outcomes.Conclusion:JSON-ASR has the characteristics of light weight,flexibility,and good scalability,which is suitable for the complex data of clinical evidence.展开更多
Objectives: Evaluating the quality of systematic reviews/meta-analysis of Wenxin granule in treating cardiac arrhythmia to provide evidence for clinical practice, and analyzing the problems in the research to identify...Objectives: Evaluating the quality of systematic reviews/meta-analysis of Wenxin granule in treating cardiac arrhythmia to provide evidence for clinical practice, and analyzing the problems in the research to identify potential research priorities for researchers. Method: The systematic reviews of Wenxin granule in treating cardiac arrhythmia were searched from 8 databases. The methodological quality and evidence quality were assessed by AMSTAR and GRADE respectively. Results: Nineteen eligible systematic reviews with 52,905 participants were included. The overall scores of AMSTAR ranged from 3 to 10 with a mean score of 6.5, the median score was 6. There were 9 (9/19, 47.37%) systematic reviews had the score of 7 or more. 6 of them with appropriate information were assessed the quality of evidence by GRADE. The results showed that the overall quality of evidence was limited (range from “very low” to “low”), no “moderate” or “high” quality of evidence existed. For the outcome reporting, no systematic reviews reported endpoints and limited evidence showed that there is causality between Wenxin granule and adverse effects/events. The outcome matrix showed that there are obvious heterogeneity and incompleteness for the outcome reporting in included systematic reviews, so that some included studies cannot be conducted meta-analysis. Meanwhile, there were studies excluded because of inappropriate outcome measures, such as outcome measures did not meet inclusion criteria, treatment time did not meet inclusion criteria, treatment time was unclear, incomplete data or the data cannot be extracted. Conclusions: Wenxin granule have limited efficacy and safety for treating arrhythmia. In the future, high quality of RCTs and systematic reviews should be conducted. Core outcome set for cardiac arrhythmia is needed to improve outcome reporting and decrease waste.展开更多
Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Num...Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.展开更多
Background:Acupuncture is used to relieve symptoms,reducing recurrence,and improve the lives of patients with skin diseases.Objective:To identify,describe,and organize the available evidence on acupuncture for atopic ...Background:Acupuncture is used to relieve symptoms,reducing recurrence,and improve the lives of patients with skin diseases.Objective:To identify,describe,and organize the available evidence on acupuncture for atopic eczema(AE)using evidence mapping of randomized controlled trials(RCTs),systematic reviews(SRs),and metaanalyses.Methods:We searched eight databases from inception to October 30,2021,for RCTs,SRs,and metaanalyses of acupuncture for patients with AE.Two reviewers screened the papers,before extracting the data and assessing the quality of the included studies.The basic and clinical characteristics,and quality of assessment of the studies were assessed using descriptive statistics and qualitative analyses.A bubble plot was used to visualize the evidence map to indicate the relationship between the type and frequency of outcomes,the quality and overall effects of acupuncture,and the outcomes of the studies.Results:Forty-five studies(Forty RCTs,five SRs,and meta-analyses)were included.The number of publications increased rapidly after 2013 and peaked in 2019.The most frequently applied intervention was one type of acupuncture therapy.The most frequent comparison was between acupuncture and active medicine.The symptomatic outcome was the most commonly used,and the quality of the included studies was relatively low.All included studies showed a significantly better outcome in the acupuncture group compared to the control group(P<0.05).Most outcomes in the included studies were of low or critically low quality.Several symptomatic outcomes and health-related quality of life outcomes in the included RCTs indicated moderate quality,while some symptomatic outcomes and global symptom improvement in the included SRs and meta-analyses indicated low quality.Conclusion:The majority of studies related to acupuncture for AE indicated promising results,but with relatively low quality;thus,further studies with more robust designs should be conducted to validate the results.展开更多
Background:Polycystic ovary syndrome(PCOS)is the primary cause of anovulatory infertility,bringing serious harm to women’s physical and mental health.Acupuncture may be an effective treatment for PCOS.However,systema...Background:Polycystic ovary syndrome(PCOS)is the primary cause of anovulatory infertility,bringing serious harm to women’s physical and mental health.Acupuncture may be an effective treatment for PCOS.However,systematic reviews(SRs)on the efficacy and safety of acupuncture for PCOS have reported inconsistent results,and the quality of these studies has not been adequately assessed.Objective:To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS,as well as to assess the quality and risks of bias of the available SRs.Search strategy:Nine electronic databases(Cochrane Library,MEDLINE,Embase,PsycINFO,CINAHL,Chinese National Knowledge Infrastructure,Wanfang Data,Chongqing VIP Chinese Science and Technology Periodical Database,and China Biology Medicine disc)were searched from their establishment to July 27,2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“acupuncture,”“polycystic ovary syndrome,”and“systematic review.”Inclusion criteria:SRs of randomized controlled trials that explored the efficacy and(or)safety of acupuncture for treating patients with PCOS were included.Data extraction and analysis:Two authors independently extracted study data according to a predesigned form.Tools for evaluating the methodological quality,risk of bias,reporting quality,and confidence in study outcomes,including A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),Risk of Bias in Systematic Reviews(ROBIS),Preferred Reporting Items for Systematic Reviews and Metaanalyses for Acupuncture(PRISMA-A),and the Grading of Recommendations Assessment,Development and Evaluation(GRADE),were used to score the included SRs.Results:A total of 885 studies were retrieved,and 11 eligible SRs were finally included in this review.The methodological quality of 2 SRs(18.18%)was low,while the other 9 SRs(81.82%)were scored as extremely low.Four SRs(36.36%)were considered to be of low risk of bias.As for reporting quality,the reporting completeness of 9 SRs(81.82%)was more than 70%.Concerning the confidence in study results,2study results were considered to have a high quality of evidence(3.13%),14(21.88%)a“moderate”quality,28(43.75%)a“low”quality,and 20(31.24%)considered a“very low”quality.Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate(CPR)and ovulation rate,and reduce luteinizing hormone/follicle-stimulating hormone ratio,homeostasis model assessment of insulin resistance,and body mass index(BMI).When compared with medicine alone,acupuncture alone also can improve CPR.Further,when compared with no intervention,acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI.Acupuncture was reported to cause no adverse events or some adverse events without serious harm.Conclusion:The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence.More high-quality studies are needed to support the use of acupuncture in PCOS.展开更多
Background:Coronavirus disease 2019(COVID-19)is a rapidly spreading disease that has caused an extensive burden to the world.Consequently,a large number of clinical trials have examined the efficacy of traditional Chi...Background:Coronavirus disease 2019(COVID-19)is a rapidly spreading disease that has caused an extensive burden to the world.Consequently,a large number of clinical trials have examined the efficacy of traditional Chinese medicine(TCM)for treating and preventing COVID-19,with coinciding proliferation of reviews summarizing these studies.Objective:This study aimed to evaluate the methodological quality and evidence quality of systematic reviews and meta-analyses on the efficacy of TCM.Search strategy:Seven electronic databases,including PubMed,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Chongqing VIP,Wanfang Data and SinoMed,were searched for systematic reviews and meta-analyses in October 2021.Search terms such as“Chinese medicine,”“Lianhua Qingwen”and“COVID-19”were used.Inclusion criteria:Systematic reviews and meta-analyses of randomized controlled trials that evaluated the efficacy of TCM treatment of COVID-19 were included.Data extraction and analysis:A Measurement Tool to Assess Systematic Reviews Version 2.0(AMSTAR 2)was used to evaluate the methodological quality.The quality of evidence was graded using the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system.Data extraction and analysis were performed by two reviewers independently.Results:There were 17 meta-analyses included in our overview.The intervention group was defined as TCM combined with Western medicine,while the control group was Western medicine alone.The methodological quality of all the included studies was moderate to poor.A total of 89 outcome indicators were evaluated,of which,8 were rated as moderate quality,39 as low quality,and 41 as very low quality.Only one outcome measure was graded as being of high quality.The moderate quality of evidence indicated that,for the treatment of COVID-19,the clinical efficacy of TCM in combination with Western medicine was better,in terms of lung recovery,rate of conversion to severe/critical cases,symptom scores,duration of symptoms,mortality,and length of hospital stay.Conclusion:Evidence from the included studies shows that,compared with conventional Western medical therapy alone,the addition of TCM to COVID-19 treatment may improve clinical outcomes.Overall,the quality of evidence of TCM for COVID-19 was moderate to poor.Meta-analyses of the use of TCM in the treatment of COVID-19 can be used for clinical decision making by accounting for the experiences of clinical experts,medical policies,and other factors.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)f...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.展开更多
基金funding via a National Breast Cancer Foundation(NBCF)Chair in Breast Cancer Prevention grant(No.EC-21-001)a National Health and Medical Research Council(NHMRC)Investigator(Leader)grant(No.1194410)supported by funding from a NBCF Investigator Initiated Research Scheme grant(No.2023/IIRS0028)。
文摘Objective:Heterogeneity in the evidence of association between lifestyle factors and breast cancer(BC)incidence hampers initiatives to modify BC risk.This overview aims to synthesise evidence from systematic reviews(SRs)to inform lifestyle-related modifications for BC prevention.Methods:We systematically searched(MEDLINE,EMBASE,and CINAHL)from January 2013 to August 2023 for SRs of the association between lifestyle factors[alcohol consumption,physical activity(PA),body mass index(BMI),smoking,breastfeeding,oral contraception(OC),hormone replacement therapy(HRT),and sedentary behavior(SB)]and BC incidence.A narrative data synthesis was performed.Results:Sixty-six SRs met the eligibility criteria.Evidence from 40 SRs indicated consistent associations between the risk of BC and postmenopausal BMI increase(relative risk increase:2%-21%),use of HRT(risk increase:23%-33%),smoking(risk increase:4%-86%),and alcohol consumption(risk increase:4%-61%).Additionally,evidence from 23 SRs suggested protective associations with PA(risk decrease:10%-39%),breastfeeding(risk decrease:9%-53%),and healthy lifestyle scores(protective about 20%-26%).However,inconsistent and/or statistically non-significant associations were found between BC incidence and premenopausal BMI increase[relative risk(RR):0.78-1.08],SB(RR:1.01-1.20),and OC use[odds ratio(OR):1.01-1.35].Conclusions:This overview identifies lifestyle factors associated with BC incidence,highlighting both harmful and protective factors.Our summary findings can support information and interventions related to modifying these factors,including limiting alcohol and smoking,or avoiding postmenopausal BMI increase and HRT.
基金supported by Chongqing Science and Technology Bureau Technology Innovation and Application Development Project(No.cstc2019jscx-msxmX0170)Chongqing Science and Health Joint Medical Research Project(No.2021MSXM208).
文摘Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.
基金supported by Chinese Medicine Development Fund of the Hong Kong SAR(No.21B2/018A)。
文摘Objective:This cross-sectional study assessed the methodological quality of systematic reviews(SRs)of Chinese herbal medicine(CHM)published in Chinese between Jan 2021 and Sep 2022.Methods:Chinese language CHM SRs were identified through literature searches across 3 international and 4 Chinese databases.Methodological quality was appraised using A MeaSurement Tool to Assess systematic Reviews 2.Logistic regressions were used to explore associations between bibliographical characteristics and quality.Results:Analyses of methodological quality found that among the 213 sampled SRs,69.5%were of critically low quality,30.5%were of low quality,and none achieved high or moderate quality.Common shortcomings included the failure to identify the studies excluded from the analysis,failure to disclose funding sources,and limited evaluation of the potential impact of bias on conclusions.Logistic regressions revealed that SRs led by corresponding authors affiliated with universities or academic institutions tended to be of lower quality than SRs led by authors affiliated with hospitals or clinical facilities.Conclusion:Recent Chinese language CHM SRs exhibited limited methodological quality,making them unlikely to support the development of clinical practice guidelines.Urgent initiatives are needed to enhance training for researchers,peer-reviewers and editors involved in the preparation and publication of SRs.Adoption of Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines in Chinese language journals is crucial to improve the relevance of SRs for Chinese medicine development.Addressing deficiencies in methodology and reporting is essential for promoting evidence-based practices and informed clinical decisions in Chinese medicine.
文摘BACKGROUND Systematic reviews(SRs)synthesize and evaluate data,mainly from randomized trials,which then guides the development of clinical recommendations in evidence-based medicine.However,the data and methodological information in the included papers can often be lacking or unclear,and reviewers usually need to contact the authors of included studies for clarifications.Contacting authors is recommended,but it is unclear how often SR teams do it,or what the level of response is.AIM To investigate how often reviewers undertake contact with the authors of included randomized controlled trials(RCTs)for clarification on data and risk of bias concerns,to explore the factors that influence whether SR authors contact or do not contact the authors,and the content and level of responses.METHODS We conducted a systematic electronic database search in MEDLINE using the search string“(systematic review)”AND“(RCT OR randomized OR trial)”for articles published between 1 January 2024 and 19 February 2024,without language restrictions.Screening and data extraction was done independently by two reviewers,and conflicts resolved by a senior author.Contact authors of included SRs were contacted for clarifications.RESULTS Of the 329 included SRs,38%(n=125)explicitly mentioned contact with the authors of included studies.The remaining 62%(n=204)did not.We attempted contact with all SR teams for clarifications and received 90 responses(19.4%).Of the 50 respondents who did not explicitly mention contact in their SRs,25(50%)replied that they did make contact.We received a total of 64 responses on the level and content of information sought.The mean±SD contacts SR teams made were 10(10),replies received 5(6.7),and response waiting time 10.1(28.3)weeks.Resources,time,poor previous experience,perceived likelihood of poor response and bias concerns were reported as barriers to attempting contact.CONCLUSION The majority of SRs published in 2024 did not confirm seeking clarifying or missing information from primary study authors.However,SR teams reported that 50%of contacted primary authors respond.Additional research can clarify this rate of response and establish methods to increase the integration of this core methodological element in SRs.
基金supported by the Evidence-based Capacity Building Project of Traditional Chinese medicine of the National Administration of Traditional Chinese Medicine(60102)the Fundamental Research Funds for the Central Public Welfare Research Institutes(49425).
文摘Objective:To summarize the characteristics and evaluate the quality of the methodology and evidence within systematic reviews(SRs)of Chinese herbal medicine(CHM)for Mycoplasma pneumoniae pneumonia(MPP)inchildren.Methods:SRs of randomized controlled trials were searched using PubMed,the Cochrane Library,Embase,the Chinese National Knowledge Infrastructure Databases(CNKI),the Chinese Scientific Journals Database(VIP),Wanfang,and the SinoMed Database.SRs on the use of CHM alone or in combination with Western medications for MPP in children were included.The study compared the effects of Western medicine alone with those of CHM.The evidence quality using the A Measurement Tool to Assess Systematic Reviews(AMSTAR)2,the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)2020,and the Grading of Recommendations,Assessment,Development,and Evaluation(GRADE)criteria.The primary indicators were the total effective rate,fever subsidence time,and cough disappearance time.The secondary outcomes were pulmonary rale disappearance time,average hospitalization time,lung X-ray infiltrate disappearance time,immunological indices,and inflammatory cytokine levels.Results:Twelve relevant SRs were included;75%(9/12)were assessed as very low quality,and 25%(3/12)Were rated as low quality using the AMSTAR 2 criteria.According to the PRISMA 2020 checklist,the average SR score was 20.3 out of a 27 point maximum.In all SRs,CHM demonstrated improvement in symptoms and signs among children with MPP.The evidence quality using the GRADE criteria ranged from"very low"(>50%)to"moderate"(<5%).The most common downgrading factor was imprecision,followed by publication bias and inconsistency.Conclusion:This overview highlights the limited quality of the methodology and evidence of the included SRs.Although the included studies showed the beneficial effects of CHM on MPP in children,it was difficult to draw firm conclusions owing to methodological flaws.
基金the National Natural Science Foundation of China:Study on the Mechanisms of Multi-target Immunomodulation by Hydrolyzed Nanzhu Tablets in Children with RRTI Based on scRNAseq Technology(No.82060825)Huang Danian-type Teacher Team of National Universities-Teacher Team of Basic Course of Chinese and Western Medicine(Ministry of Education Teacher Letter[2022]No.2)+2 种基金Guangxi Famous Chinese Medicine Doctor Lin Jiang Inheritance Studio(Gui TCM Science and Education Development[2021]No.6)Guangxi First-class Discipline of Chinese Medicine(Gui Textbook Research[2022]No.1)Guangxi Interdisciplinary Innovation Team of Chinese Medicine(GZKJ2302)。
文摘OBJECTIVE:To evaluate and summarise the evidence from published Meta-analyses/systematic reviews(MAs/SRs)of Traditional Chinese Medicine(TCM)in the treatment of recurrent respiratory tract infections(RRTIs)and to provide a scientific basis for the clinical treatment of RRTIs with TCM.METHODS:Studies were retrieved from Chinese and English databases including the China National Knowledge Infrastructure,Wanfang database,China Science and Technology Journal Database,SinoM ed,PubM ed,Web of Science,the Cochrane Library and EMbase from their establishment date to March 2023.Involved studies were screened,extracted,and evaluated for quality by two researchers independently.The a measurement tool to assess systematic reviews(AMSTAR)2 scale was used for methodological quality evaluation,as well as the preferred reporting items for systematic reviews and Meta-analyses(PRISMA)2020 statement for report quality evaluation,the risk of bias in systematic reviews(ROBIS)tool for risk of bias,and the grading of recommendations,assessment,development and evaluation(GRADE)quality assessment tool for evidence quality.RESULTS:Twenty MAs/SRs studies were included,including analyses of 274 original studies involving 38335 patients with RRTIs.The AMSTAR 2 scale evaluation results showed that 19 studies were of very low quality and one of moderate quality.The ROBIS evaluation results showed that 11 MAs/SRs were at high risk and nine at low risk of bias.The PRISMA 2020 report quality showed the included studies had scores between 23.5 and 35.5,among them one with high quality,17 with moderate quality and two with low quality.The GRADE system results showed that among 126 outcome indicators,only 17 had moderate quality of evidence,27 had low quality,82 had very low quality,and none had high quality.CONCLUSIONS:The MAs/SRs methodological quality of using TCM for treatment RRTIs is generally poor,the quality of reports as well as of evidence is generally low,and the risk of bias is high;therefore we should treat these results with caution.
基金supported by the National Natural Science Foundation of China(grant No.81500522)the Science and Technology Department of Sichuan Province(No.2020YFS0090 and No.2020YFS0046).
文摘This umbrella review aimed to summarize and provide a general evaluation of the effectiveness of current treatments for male infertility and assess the quality of evidence and possible biases.An umbrella review of systematic reviews and meta-analyses available in PubMed,Web of Science,and Scopus,covering studies published up to October 2023,was conducted.Sperm concentration,morphology,and motility were used as endpoints to evaluate the effectiveness of the treatments.Of 2998 studies,18 published meta-analyses were extracted,yielding 90 summary effects on sperm concentration(n=36),sperm morphology(n=26),and sperm motility(n=28)on 28 interventions.None of the meta-analyses were classified as having low methodological quality,whereas 12(66.7%)and 6(33.3%)had high and moderate quality,respectively.Of the 90 summary effects,none were rated high-evidence quality,whereas 53.3%(n=48),25.6%(n=23),and 21.1%(n=19)were rated moderate,low,and very low,respectively.Significant improvements in sperm concentration,morphology,and motility were observed with pharmacological interventions(N-acetyl-cysteine,antioxidant therapy,aromatase inhibitors,selective estrogen receptor modulators,hormones,supplements,and alpha-lipoic acid)and nonpharmacological interventions(varicocele repair and redo varicocelectomy).In addition,vitamin supplementation had no significant positive effects on sperm concentration,motility,or morphology.Treatments for male infertility are increasingly diverse;however,the current evidence is poor because of the limited number of patients.Further well-designed studies on single treatment and high-quality meta-analysis of intertreatment comparisons are recommended.
基金Supported by National Key R&D Program of China2019YFC1712200International standards research on clinical research and service of AcupunctureMoxibustion2019YFC1712205。
文摘Objective:To assess the reliability of the methodological quality and outcome measures of systematic reviews(SR)/meta-analysis of premature ovarian insufficiency(POI) treated with acupuncture.Methods:SR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed,Web of Science,EMBase,the Cochran Library,Chinese biomedical literature database(SinoMed),China journal full-text database(CNKI),Wanfang data knowledge service platform(Wanfang)and VIP information Chinese periodical service platform(VIP),from inception to 1 st May 2021.Using A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2) scale and Grades of Recommendations Assessment,Development and Evaluation(GRADE) system,the methodological quality and outcome measures of the included studies were appraised.Results:Ten articles of SR/meta-analysis were included,published from 2015 to 2020.Using AMSTAR 2,5 articles of SR/meta-analysis were rated as critical low quality in methods,3 articles as low quality,and2 articles as moderate quality.The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low,that of 25 outcomes was low and that of 3 outcomes was moderate.Conclusion:The methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture,which may affect the translation of the SR/metaanalysis findings into clinical practice.It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis,as well as the robustness of design and implementation of randomized controlled trials(RCTs),in order to generate high quality evidences for clinical decision-making and practice.
基金Supported by National Natural Science Foundation of China:8140349481303025,reference number:2014CB543201
文摘Background The clinical efficacy of acupuncture is a topic that has received worldwide attention. In recent years, the rise of evidence-based medicine has led to calls for the clinical curative effects of acupuncture to be tested through objective, standardized, systematic evaluation. The results of systematic reviews for clinical trials on the efficacy of acupuncture directly affect the development of acupuncture medicine. Because of its rigorous methods and its capability to provide the very latest results, the Cochrane Database of Systematic Reviews（CDSR） is recognized worldwide as one of the most reliable sources for scientific evidence. Objective Assess the current system evaluation related to acupuncture in CDSR and the Cochrane Collaboration. Methods Based on the protocols described in the Cochrane library review and the Cochrane Collaboration, and considering the registered titles in the data base, the following key terms were selected： acupuncture, transcutaneous electrical nerve stimulation, electroacupuncture, needle and acupressure. Results The 275 articles were retrieved. According to inclusion and exclusion criteria, 139 articles were eventually chosen for inclusion. We found a growing number of acupuncture related CDSR annual reviews and protocols on the overall Before 2014. The published acupuncture related reviews, protocols and registered titles concerning the subject involve 34 Cochrane Review Groups. Through analyzing the 84 reviews related to acupuncture, we concluded that these studies show a rather low rate of efficacy overall for acupuncture. Of the 84, 19（22.62%） concluded that there is evidence for the efficacy of acupuncture,2（2.38%） showed acupuncture treatment were not more effective than controls and the remaining 63（75.00%） showed that the efficacy of acupuncture were uncertain. Conclusions By analyzing and summarizing the acupuncture reviews published in the CDSR before 2014, we found that current research shows acupuncture treatment is most effective for treating pain and related symptoms（57.89%）. However, studies showing lack of efficacy or uncertain results far outweighed the studies with positive results. We discuss the possible reasons for this and beleive it is related to the overall quality of research, poorly designed sham acupuncture, lack of standard procedures for locating points and needling, and lack of attention to individual differences.
基金The study was financially supported by the Major Program of the National Natural Science Foundation of China(No.81590951).
文摘Objective:In the current systematic review on acupuncture and/or moxibustion for lumbar disc herniation(LDH),we evaluated the methodology and quality of evidence and reports to provide necessary information for accurate clinical decision-making regarding acupuncture and/or moxibustion for LDH.Methods:From databases such as CBM(Chinese biomedical literature database),VIP(China science and technology journal database),CNKI(China national knowledge infrastructure),WF(Wanfang database),Web of Science,Embase,Medline,and Cochrane Library,systematic reviews on acupuncture and/or moxibustion for LDH were retrieved,and the methodological quality of the literature was evaluated according to the assessment of multiple systematic reviews(AMSTAR)list.Furthermore,the grading of recommendations assessment,development and evaluation(GRADE)system was used to grade the quality of evidence and the preferred reporting items for systematic reviews and meta-analyses(PRISMA)statement to evaluate the quality of the report.Results:A total of 18 systematic reviews were included,and the conclusion is that acupuncture and/or moxibustion have some advantages in terms of efficacy and safety with regard to LDH treatment.According to the AMSTAR score,there were 4 high-quality studies,13 moderate-quality studies,and 1 low-quality study.GRADE showed that quality of evidence such as total effective rate of LDH and VAS was low and that of other forms of evidence was lower.The PRISMA statement showed that 8 articles were in line with 20 or more of the 27 items,and 10 articles were in line with 10-19 of the 27 items.Conclusion:At present,acupuncture and/or moxibustion for LDH has a good curative effect.More importantly,its methodological quality was of moderate level and the report quality was generally good and relatively complete.However,the poor quality of the original research results was reflected in the quality of evidence.More studies are needed to make sure whether acupuncture is more effective than other treatment methods.
文摘This review aims to clarify the clinical significance of systematic reviews and meta-analyses by illustrating several classical examples.Firstly,systematic reviews can provide the highest level of evidence for clinical decisions.Secondly,systematic reviews can propose unresolved issues and future directions.Thirdly,systematic reviews can avoid harm to the human body.Fourthly,systematic reviews can prevent a waste of resources.Generally speaking,clinical researchers should be encouraged to perform systematic reviews and metaanalyses.
基金Youth Project of National Natural Science Foundation (81804095)
文摘Objective: To overview the systematic reviews of acupuncture for Post-stroke Dysphagia. Methods: The Chinese and English databases were searched for the systematic reviews of dysphagia after acupuncture treatment. The retrieval time was until October 30, 2019. The final literature was evaluated for bias risk, methodology quality and evidence quality by using ROBIS tool, AMSTER-2 scale and GRADE method. Results: 9 systematic reviews and 36 outcomes were included. ROBIS bias risk assessment results show that all the studies are high bias risk;AMSTER-2 methodology quality assessment results show that all the systems are of very low quality;GRADE grading shows that there are only 7 intermediate evidences in 36 clinical evidences, the rest are low-level evidences or very low-level evidences, and there are multiple intermediate evidences in the clinical efficacy of acupuncture in the treatment of dysphagia after stroke. In addition, acupuncture can significantly improve the scores of all kinds of swallowing function related scales, such as Tengdao food intake swallowing function grade, swallowing disorder specific quality of life score, standard swallowing function evaluation scale, and the incidence of adverse reactions is low. Conclusion: Acupuncture is effective in the treatment of dysphagia after stroke. It can improve the scores of various swallowing function scales and has high safety. However, the risk of systematic evaluation bias is high, the quality of methodology is low, and the level of clinical evidence is low as a whole. In the future, the relevant research design should be more rigorous, and the research report should be written in strict accordance with the PRISMA statement.
文摘Background and aim： Several systematic reviews and meta-analyses published within the past years have examined the associations of Mediterranean-style diets （MedSDs） on cognitive. However, these reviews have not been evaluated for satisfying Contemporary methodologies quality standards. At the same time, due to the high demand for related care during the aging process in China, it is necessary to summarize the ex-isting system evaluation and evaluate the quality of it, so as to provide strong evidence for the development of relevant work and to standardize the research process and methods in this field. This study evaluated the quality of recent systematic reviews and meta-analyses on MedSD and cognitive outcomes by using an established methodology quality scale, and to provide some valuable references for future research and Chinese systematic review and meta-analysis developing. Methods： We used the AMSTAR Methodology Quality Assessment Scale to evaluate the quality of methodology of the existing meta-analyses and systematic review. Meta analysis and systematic review that meets our criteria must contain the following characteristics： 1） used systematic or meta-analytic procedures to review the lit-erature, and 2） had MedSD interventions independently. Results： Reviews satisfied with 5 to 9 of the AMSTAR MedSD items （mean 7.35, standard deviation： 1.27）, quality is above average with those published in higher-impact journals having a greater quality score. Conclusion： These data suggest that current meta-analyses/systematic reviews evaluating the effect of MedSD on cognitive do not fully meet contemporary methodology quality standards. The methodological quality of the literature needs to be im- proved. As a result, there are more research questions to answer to enhance our understanding of how MedSD affects cognitive. To clarify associations between MedSD and cognitive, future meta-analyses and systematic reviews should not only follow methodology quality standards but also include more statistical modeling results when data allow. And in order to make the conclusions more reliable, we expect higher quality RCTs in the future.
基金the National Key R&D Program of China(Grant no.2019YFC1709803)National Natural Science Foundation of China(Grant no.81873183).
文摘Objectives:The aim of this study was to investigate and develop a data storage and exchange format for the process of automatic systematic reviews(ASR)of traditional Chinese medicine(TCM).Methods:A lightweight and commonly used data format,namely,JavaScript Object Notation(JSON),was introduced in this study.We designed a fully described data structure to collect TCM clinical trial information based on the JSON syntax.Results:A smart and powerful data format,JSON-ASR,was developed.JSON-ASR uses a plain-text data format in the form of key/value pairs and consists of six sections and more than 80 preset pairs.JSON-ASR adopts extensible structured arrays to support the situations of multi-groups and multi-outcomes.Conclusion:JSON-ASR has the characteristics of light weight,flexibility,and good scalability,which is suitable for the complex data of clinical evidence.
基金National Natural Science Foundation of China [No: 81430098].
文摘Objectives: Evaluating the quality of systematic reviews/meta-analysis of Wenxin granule in treating cardiac arrhythmia to provide evidence for clinical practice, and analyzing the problems in the research to identify potential research priorities for researchers. Method: The systematic reviews of Wenxin granule in treating cardiac arrhythmia were searched from 8 databases. The methodological quality and evidence quality were assessed by AMSTAR and GRADE respectively. Results: Nineteen eligible systematic reviews with 52,905 participants were included. The overall scores of AMSTAR ranged from 3 to 10 with a mean score of 6.5, the median score was 6. There were 9 (9/19, 47.37%) systematic reviews had the score of 7 or more. 6 of them with appropriate information were assessed the quality of evidence by GRADE. The results showed that the overall quality of evidence was limited (range from “very low” to “low”), no “moderate” or “high” quality of evidence existed. For the outcome reporting, no systematic reviews reported endpoints and limited evidence showed that there is causality between Wenxin granule and adverse effects/events. The outcome matrix showed that there are obvious heterogeneity and incompleteness for the outcome reporting in included systematic reviews, so that some included studies cannot be conducted meta-analysis. Meanwhile, there were studies excluded because of inappropriate outcome measures, such as outcome measures did not meet inclusion criteria, treatment time did not meet inclusion criteria, treatment time was unclear, incomplete data or the data cannot be extracted. Conclusions: Wenxin granule have limited efficacy and safety for treating arrhythmia. In the future, high quality of RCTs and systematic reviews should be conducted. Core outcome set for cardiac arrhythmia is needed to improve outcome reporting and decrease waste.
基金supported by grants from the National Natural Science Foundation of China(No.8207455481774430)the Foundation of the Science and Technology Department of Sichuan Province,China(No.2021YJ0197)。
文摘Background: Functional constipation(FC) is one of the most prevalent functional gastrointestinal disorders. Dissatisfaction with medications prescribed to treat FC may lead patients to seek alternative treatments. Numerous systematic reviews(SRs) examining the use of acupuncture to treat FC have reported inconsistent results, and the quality of these studies has not been fully evaluated.Objective: In this overview, we evaluated and summarized clinical evidence on the effectiveness and safety of acupuncture for treating FC and evaluated the quality and bias of the SRs we reviewed.Search strategy: The search strategy was structured by medical subject headings and search terms such as‘‘acupuncture therapy" and ‘‘functional constipation." Electronic searches were conducted in eight databases from their inception to September 2020.Inclusion criteria: SRs that investigated the effectiveness and safety of acupuncture for managing FC were included.Data extraction and analysis: Two authors independently extracted information and appraised the methodology, reporting accuracy, quality of evidence, and risk of bias using the following critical appraisal tools:(1) A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2);(2) Risk of Bias in Systematic Reviews(ROBIS);(3) Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture(PRISMA-A);and(4) the Grading of Recommendations, Assessment, Development and Evaluations(GRADE). A j index was used to score the level of agreement between the 2 reviewers.Results: Thirteen SRs that examined the clinical utility of acupuncture for treating FC were identified.Using the AMSTAR 2 tool, we rated 92.3%(12/13) of the SRs as ‘‘critically low" confidence and one study as ‘‘low" confidence. Using the ROBIS criteria, 38.5%(5/13) of the SRs were considered to have ‘‘low risk"of bias. Based on PRISMA-A, 76.9%(10/13) of the SRs had over 70% compliance with reporting standards.The inter-rater agreement was good for AMSTAR 2, ROBIS, and PRISMA-A. Using the GRADE tool, we classified 22.5%(9/40) of the measured outcomes as ‘‘moderate" quality, 57.5%(23/40) as ‘‘low" quality, and 20.0%(8/40) as ‘‘very low" quality. The inter-rater agreement was moderate when using GRADE.Descriptive analyses indicated that acupuncture was more efficacious than sham acupuncture for improving weekly complete spontaneous bowel movements(CSBMs) and for raising the Bristol Stool Form Scale(BSFS) score. Acupuncture appeared to be superior to anti-constipation drugs for improving weekly spontaneous bowel movements, the total effective rate, and the Patient Assessment of Constipation Quality of Life score. Although ten SRs mentioned the occurrence of adverse events, serious adverse events were not associated with acupuncture treatment.Conclusion: Acupuncture may be more efficacious than sham acupuncture for improving CSBMs and BSFS scores and may be superior to anti-constipation drugs for improving bowel movement frequency, as well as quality of life. Limitations to current studies and inconsistent evidence suggest a need for more rigorous and methodologically sound SRs to draw definitive conclusions.
基金Supported by China Academy of Chinese Medical Sciences Innovation FundC12021A03503National Natural Science Fund of China81973968+1 种基金Fundamental Research Funds for Central Public Welfare Scientific Research InstitutesZZ13-024-9"The Belt and Road"TCM Cooperation Project of China Academy of Chinese Medical Sciences in 2019GH201901。
文摘Background:Acupuncture is used to relieve symptoms,reducing recurrence,and improve the lives of patients with skin diseases.Objective:To identify,describe,and organize the available evidence on acupuncture for atopic eczema(AE)using evidence mapping of randomized controlled trials(RCTs),systematic reviews(SRs),and metaanalyses.Methods:We searched eight databases from inception to October 30,2021,for RCTs,SRs,and metaanalyses of acupuncture for patients with AE.Two reviewers screened the papers,before extracting the data and assessing the quality of the included studies.The basic and clinical characteristics,and quality of assessment of the studies were assessed using descriptive statistics and qualitative analyses.A bubble plot was used to visualize the evidence map to indicate the relationship between the type and frequency of outcomes,the quality and overall effects of acupuncture,and the outcomes of the studies.Results:Forty-five studies(Forty RCTs,five SRs,and meta-analyses)were included.The number of publications increased rapidly after 2013 and peaked in 2019.The most frequently applied intervention was one type of acupuncture therapy.The most frequent comparison was between acupuncture and active medicine.The symptomatic outcome was the most commonly used,and the quality of the included studies was relatively low.All included studies showed a significantly better outcome in the acupuncture group compared to the control group(P<0.05).Most outcomes in the included studies were of low or critically low quality.Several symptomatic outcomes and health-related quality of life outcomes in the included RCTs indicated moderate quality,while some symptomatic outcomes and global symptom improvement in the included SRs and meta-analyses indicated low quality.Conclusion:The majority of studies related to acupuncture for AE indicated promising results,but with relatively low quality;thus,further studies with more robust designs should be conducted to validate the results.
基金supported by grants from the National Natural Science Foundation of China (No. 82174517)
文摘Background:Polycystic ovary syndrome(PCOS)is the primary cause of anovulatory infertility,bringing serious harm to women’s physical and mental health.Acupuncture may be an effective treatment for PCOS.However,systematic reviews(SRs)on the efficacy and safety of acupuncture for PCOS have reported inconsistent results,and the quality of these studies has not been adequately assessed.Objective:To summarize and evaluate the current evidence on the efficacy and safety of acupuncture for PCOS,as well as to assess the quality and risks of bias of the available SRs.Search strategy:Nine electronic databases(Cochrane Library,MEDLINE,Embase,PsycINFO,CINAHL,Chinese National Knowledge Infrastructure,Wanfang Data,Chongqing VIP Chinese Science and Technology Periodical Database,and China Biology Medicine disc)were searched from their establishment to July 27,2022.Based on the principle of combining subject words with text words,the search strategy was constructed around search terms for“acupuncture,”“polycystic ovary syndrome,”and“systematic review.”Inclusion criteria:SRs of randomized controlled trials that explored the efficacy and(or)safety of acupuncture for treating patients with PCOS were included.Data extraction and analysis:Two authors independently extracted study data according to a predesigned form.Tools for evaluating the methodological quality,risk of bias,reporting quality,and confidence in study outcomes,including A Measurement Tool to Assess Systematic Reviews 2(AMSTAR 2),Risk of Bias in Systematic Reviews(ROBIS),Preferred Reporting Items for Systematic Reviews and Metaanalyses for Acupuncture(PRISMA-A),and the Grading of Recommendations Assessment,Development and Evaluation(GRADE),were used to score the included SRs.Results:A total of 885 studies were retrieved,and 11 eligible SRs were finally included in this review.The methodological quality of 2 SRs(18.18%)was low,while the other 9 SRs(81.82%)were scored as extremely low.Four SRs(36.36%)were considered to be of low risk of bias.As for reporting quality,the reporting completeness of 9 SRs(81.82%)was more than 70%.Concerning the confidence in study results,2study results were considered to have a high quality of evidence(3.13%),14(21.88%)a“moderate”quality,28(43.75%)a“low”quality,and 20(31.24%)considered a“very low”quality.Descriptive analyses suggested that combining acupuncture with other medicines can effectively improve the clinical pregnancy rate(CPR)and ovulation rate,and reduce luteinizing hormone/follicle-stimulating hormone ratio,homeostasis model assessment of insulin resistance,and body mass index(BMI).When compared with medicine alone,acupuncture alone also can improve CPR.Further,when compared with no intervention,acupuncture had a better effect in promoting the recovery of menstrual cycle and reducing BMI.Acupuncture was reported to cause no adverse events or some adverse events without serious harm.Conclusion:The efficacy and safety of acupuncture for PCOS remains uncertain due to the limitations and inconsistencies of current evidence.More high-quality studies are needed to support the use of acupuncture in PCOS.
基金This work was supported by the Key Research and Development Projects from the Department of Science and Technology of Zhejiang Province(No.2020c03126)the Health Commission of Zhejiang Province(No.2017KY502),China.
文摘Background:Coronavirus disease 2019(COVID-19)is a rapidly spreading disease that has caused an extensive burden to the world.Consequently,a large number of clinical trials have examined the efficacy of traditional Chinese medicine(TCM)for treating and preventing COVID-19,with coinciding proliferation of reviews summarizing these studies.Objective:This study aimed to evaluate the methodological quality and evidence quality of systematic reviews and meta-analyses on the efficacy of TCM.Search strategy:Seven electronic databases,including PubMed,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Chongqing VIP,Wanfang Data and SinoMed,were searched for systematic reviews and meta-analyses in October 2021.Search terms such as“Chinese medicine,”“Lianhua Qingwen”and“COVID-19”were used.Inclusion criteria:Systematic reviews and meta-analyses of randomized controlled trials that evaluated the efficacy of TCM treatment of COVID-19 were included.Data extraction and analysis:A Measurement Tool to Assess Systematic Reviews Version 2.0(AMSTAR 2)was used to evaluate the methodological quality.The quality of evidence was graded using the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)system.Data extraction and analysis were performed by two reviewers independently.Results:There were 17 meta-analyses included in our overview.The intervention group was defined as TCM combined with Western medicine,while the control group was Western medicine alone.The methodological quality of all the included studies was moderate to poor.A total of 89 outcome indicators were evaluated,of which,8 were rated as moderate quality,39 as low quality,and 41 as very low quality.Only one outcome measure was graded as being of high quality.The moderate quality of evidence indicated that,for the treatment of COVID-19,the clinical efficacy of TCM in combination with Western medicine was better,in terms of lung recovery,rate of conversion to severe/critical cases,symptom scores,duration of symptoms,mortality,and length of hospital stay.Conclusion:Evidence from the included studies shows that,compared with conventional Western medical therapy alone,the addition of TCM to COVID-19 treatment may improve clinical outcomes.Overall,the quality of evidence of TCM for COVID-19 was moderate to poor.Meta-analyses of the use of TCM in the treatment of COVID-19 can be used for clinical decision making by accounting for the experiences of clinical experts,medical policies,and other factors.
基金Evidence-based Capacity Building Project for Basic Traditional Chinese Medicine-Specialized Diseases,No.2019XZZX-XH012Shanghai Three-year Action Plan for Accelerating the Development of Traditional Chinese Medicine,No.ZY(2018-2020)-CCCX-2002-01.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)affects more than one-quarter of the global population.Due to the lack of approved chemical agents,many patients seek treatment from traditional Chinese medicine(TCM)formulas.A variety of systematic reviews have been published regarding the effectiveness and safety of TCM formulas for NAFLD.AIM To critically appraise available systematic reviews and sort out the high-quality evidence on TCM formulas for the management of NAFLD.METHODS Seven databases were systematically searched from their inception to 28 February 2020.The search terms included“non-alcoholic fatty liver disease,”“Chinese medicines,”“systematic review,”and their synonyms.Systematic reviews involving TCM formulas alone or in combination with conventional medications were included.The methodological quality and risk of bias of eligible systematic reviews were evaluated by using A Measure Tool to Assess Systematic Reviews 2(AMSTAR 2)and Risk of Bias in Systematic Review(ROBIS).The quality of outcomes was assessed by the Grading of Recommendations Assessment,Development and Evaluation(GRADE)system.RESULTS Seven systematic reviews were ultimately included.All systematic reviews were conducted based on randomized controlled trials and published in the last decade.According to the AMSTAR 2 tool,one systematic review was judged as having a moderate confidence level,whereas the other studies were rated as having a low or extremely low level of confidence.The ROBIS tool showed that the included systematic reviews all had a high risk of bias due to insufficient consideration of identified concerns.According to the GRADE system,only two outcomes were determined as high quality;namely,TCM formulas with the HuoXueHuaYu principle were better than conventional medications in ultrasound improvement,and TCM formulas were superior to antioxidants in alanine aminotransferase normalization.Other outcomes were downgraded to lower levels,mainly because of heterogeneity among studies,not meeting optimal information sample size,and inclusion of excessive numbers of small sample studies.Nevertheless,the evidence quality of extracted outcomes should be further downgraded when applying to clinical practice due to indirectness.CONCLUSION The quality of available systematic reviews was not satisfactory.Researchers should avoid repeatedly conducting systematic reviews in this area and focus on designing rigorous randomized controlled trials to support TCM formula applications.
