目的对芪参益气滴丸治疗慢性心力衰竭的系统评价/Meta分析(SRs/MAs)进行再评价,以评估该领域研究质量和临床证据现状。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、WanFang Data和CBM数据库,搜集与研究目...目的对芪参益气滴丸治疗慢性心力衰竭的系统评价/Meta分析(SRs/MAs)进行再评价,以评估该领域研究质量和临床证据现状。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、WanFang Data和CBM数据库,搜集与研究目的相关的SRs/MAs,检索时限均为建库至2022年12月31日。由2名研究者独立筛选文献、提取资料,使用AMSTAR-2进行方法学质量评价,使用ROBIS评价偏倚风险,使用PRISMA进行报告质量评价,最后采用GRADE系统进行证据质量分级。结果最终纳入17个SRs/MAs。但纳入SRs/MAs的方法学质量、报告质量、偏倚风险评价结果及结局指标的证据等级均存在缺陷。根据AMSTAR-2评估结果,SRs/MAs的方法学质量以极低级为主;根据ROBIS评价结果,只有少数SRs/MAs被评估为低偏倚风险;PRISMA评价结果表明纳入的24项研究的报告质量较完整;根据GRADE证据分级结果,84个结局指标中证据质量为低级和极低级占比94%,局限性是导致其降级的主要因素,其次是发表偏倚、不一致性、不精确性及间接性。结论目前芪参益气滴丸治疗慢性心力衰竭具有较好的临床疗效,但是临床研究和二次研究设计和报告的规范性和科学性不足,导致临床推荐意见证据质量不高,还需要进一步规范和提高临床研究和二次研究质量。展开更多
Objective: To critically evaluate and summarize the methodological quality of systematic reviews(SRs)and present objective and important outcomes on the effectiveness of traditional Chinese medicine(TCM) therapies, in...Objective: To critically evaluate and summarize the methodological quality of systematic reviews(SRs)and present objective and important outcomes on the effectiveness of traditional Chinese medicine(TCM) therapies, including Chinese herbal medicine(CHM), acupuncture, and moxibustion, for diarrheapredominant irritable bowel syndrome(IBS-D).Methods: We conducted a comprehensive literature search for SRs in 7 databases until April 16, 2022.Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2(AMSTAR-2), the Risk of Bias in Systematic reviews(ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis(PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation(GRADE) was used to rate the quality of evidence.Results: IBS-D patients included in 12 reviews were diagnosed in accordance with the Rome criteria, 9 reviews focused on CHM, 2 articles observed moxibustion and heat-sensitive moxibustion, 1 article studied acupuncture and CHM. The outcomes of the SRs were the effectiveness rate, the total effectiveness rate,global symptom improvement, and adverse effects. Based on AMSTAR-2, which measures the quality of methodology, all of the included studies were of low or critically low quality. According to the ROBIS tool, 10 SRs(83.33%) had a high risk of bias. With the PRISMA checklist, only 3 SRs reached over 90% compliance.Based on GRADE, most evidence was of low quality, and there was a moderate quality of evidence that the effectiveness rate of modified-Tongxie Yaofang was superior to Western medicine in the treatment of IBS-D.Conclusion: Given the suboptimal reporting and methodological quality of existing SRs, more studies are needed to clarify whether TCM therapies are more effective or safe than pharmacological medicine.Future studies should combine evidence-based medicine with TCM research according to the characteristics of TCM.展开更多
Objective:To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making.Methods:We conducted...Objective:To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making.Methods:We conducted an overview of systematic reviews (SRs).Two English-language and four Chinese-language electronic databases were searched from inception to March 31,2018.Published SRs and meta-analyses evaluating CHM use in children with HFMD and reporting clinically-relevant outcomes such as time to fever resolution were eligible for inclusion in this overview.Reviews were accepted if the intervention featured CHM with or without other treatment.Two authors evaluated the methodological quality of the included SRs by using ASMTAR and ROBIS.Results:Thirty SRs comprising 90 244 children with HFMD were included in this overview of SRs.All SRs were published in Chinese between 2011 and 2017.All intervention arms received CHM with or without conventional treatment and were compared against control arms receiving no treatment,conventional treatment alone,or placebo.All 30 reviews reported the time to fever resolution and results demonstrated that CHM had a greater benefit in reducing fever compared with controls.Twenty-three reviews reported the time to rash resolution which presented similar results.Fourteen SRs reported the time to oral ulcer healing and CHM demonstrated a significantly reduced time to resolution compared to controls.The quality of the included SRs was low to moderate as assessed by the AMSTAR tool.Conclusion:Published reviews demonstrated potential benefits of CHM in children with HFMD.Overall,the methodological quality of reviews included in this overview of SRs was low and our findings should be interpreted with caution.We would strongly recommend that future SRs be designed and reported rigorously following PRISMA in order to provide more robust evidence on which to base clinical guidance.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
文摘目的对芪参益气滴丸治疗慢性心力衰竭的系统评价/Meta分析(SRs/MAs)进行再评价,以评估该领域研究质量和临床证据现状。方法计算机检索PubMed、EMbase、Cochrane Library、Web of Science、CNKI、WanFang Data和CBM数据库,搜集与研究目的相关的SRs/MAs,检索时限均为建库至2022年12月31日。由2名研究者独立筛选文献、提取资料,使用AMSTAR-2进行方法学质量评价,使用ROBIS评价偏倚风险,使用PRISMA进行报告质量评价,最后采用GRADE系统进行证据质量分级。结果最终纳入17个SRs/MAs。但纳入SRs/MAs的方法学质量、报告质量、偏倚风险评价结果及结局指标的证据等级均存在缺陷。根据AMSTAR-2评估结果,SRs/MAs的方法学质量以极低级为主;根据ROBIS评价结果,只有少数SRs/MAs被评估为低偏倚风险;PRISMA评价结果表明纳入的24项研究的报告质量较完整;根据GRADE证据分级结果,84个结局指标中证据质量为低级和极低级占比94%,局限性是导致其降级的主要因素,其次是发表偏倚、不一致性、不精确性及间接性。结论目前芪参益气滴丸治疗慢性心力衰竭具有较好的临床疗效,但是临床研究和二次研究设计和报告的规范性和科学性不足,导致临床推荐意见证据质量不高,还需要进一步规范和提高临床研究和二次研究质量。
基金supported by the National Key Research and Development Program of China (2019YFC1709004)。
文摘Objective: To critically evaluate and summarize the methodological quality of systematic reviews(SRs)and present objective and important outcomes on the effectiveness of traditional Chinese medicine(TCM) therapies, including Chinese herbal medicine(CHM), acupuncture, and moxibustion, for diarrheapredominant irritable bowel syndrome(IBS-D).Methods: We conducted a comprehensive literature search for SRs in 7 databases until April 16, 2022.Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2(AMSTAR-2), the Risk of Bias in Systematic reviews(ROBIS) tool, and the Preferred Reporting Item for Systematic Review and Meta-analysis(PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation(GRADE) was used to rate the quality of evidence.Results: IBS-D patients included in 12 reviews were diagnosed in accordance with the Rome criteria, 9 reviews focused on CHM, 2 articles observed moxibustion and heat-sensitive moxibustion, 1 article studied acupuncture and CHM. The outcomes of the SRs were the effectiveness rate, the total effectiveness rate,global symptom improvement, and adverse effects. Based on AMSTAR-2, which measures the quality of methodology, all of the included studies were of low or critically low quality. According to the ROBIS tool, 10 SRs(83.33%) had a high risk of bias. With the PRISMA checklist, only 3 SRs reached over 90% compliance.Based on GRADE, most evidence was of low quality, and there was a moderate quality of evidence that the effectiveness rate of modified-Tongxie Yaofang was superior to Western medicine in the treatment of IBS-D.Conclusion: Given the suboptimal reporting and methodological quality of existing SRs, more studies are needed to clarify whether TCM therapies are more effective or safe than pharmacological medicine.Future studies should combine evidence-based medicine with TCM research according to the characteristics of TCM.
基金This study was supported by The National Natural Science Foundation of China(81673828)Capacity Building in Evidence-based Chinese Medicine and Internationalization Project(1000061020008).
文摘Objective:To summarize the use of Chinese herbal medicines (CHM) for the treatment of hand-foot-and-mouth disease (HFMD) in children and to provide high-level evidence for clinical decision-making.Methods:We conducted an overview of systematic reviews (SRs).Two English-language and four Chinese-language electronic databases were searched from inception to March 31,2018.Published SRs and meta-analyses evaluating CHM use in children with HFMD and reporting clinically-relevant outcomes such as time to fever resolution were eligible for inclusion in this overview.Reviews were accepted if the intervention featured CHM with or without other treatment.Two authors evaluated the methodological quality of the included SRs by using ASMTAR and ROBIS.Results:Thirty SRs comprising 90 244 children with HFMD were included in this overview of SRs.All SRs were published in Chinese between 2011 and 2017.All intervention arms received CHM with or without conventional treatment and were compared against control arms receiving no treatment,conventional treatment alone,or placebo.All 30 reviews reported the time to fever resolution and results demonstrated that CHM had a greater benefit in reducing fever compared with controls.Twenty-three reviews reported the time to rash resolution which presented similar results.Fourteen SRs reported the time to oral ulcer healing and CHM demonstrated a significantly reduced time to resolution compared to controls.The quality of the included SRs was low to moderate as assessed by the AMSTAR tool.Conclusion:Published reviews demonstrated potential benefits of CHM in children with HFMD.Overall,the methodological quality of reviews included in this overview of SRs was low and our findings should be interpreted with caution.We would strongly recommend that future SRs be designed and reported rigorously following PRISMA in order to provide more robust evidence on which to base clinical guidance.
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.
