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Moura-Coelho N, Papa-Vettorazzi R, Reyes A, Cunha JP, Güell JL. Ultrathin DSAEK versus DMEK - Review of systematic reviews. Eur J Ophthalmol 2024; 34:913-923. [PMID: 37964555 DOI: 10.1177/11206721231214605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The efficacy and safety of Descemet's membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) have been recently compared in several systematic reviews (SRs). The aim of this study was to assess the evidence quality of such SRs, in order to obtain a scientifically rigorous comparison between the two techniques. We performed a systematic review of SRs and meta-analyses comparing the efficacy and safety between UT-DSAEK and DMEK up to 24th March 2023, using 3 electronic databases (PubMed, Cochrane Library, Google Scholar) plus manual reference search. Specific outcomes analyzed included best-corrected visual acuity (BCVA), endothelial cell density (ECD), rebubbling rate, and other postoperative complications. Of 90 titles/abstracts screened, four SRs met the inclusion criteria. All SRs adequately analyzed potential bias of the included studies. One SR raised concern for potential literature search bias and two SRs have heterogeneity in some outcomes analyzed. All SRs found higher BCVA after DMEK, but one SR reported significant heterogeneity. All SRs found significant heterogeneity in ECD analysis, with one SR providing inconsistent analysis of this outcome. Three SRs analyzed rebubbling rates, favoring UT-DSAEK over DMEK. Three SRs concluded a higher overall complication rate after DMEK, although rebubbling may be a confounding factor. This systematic review clarifies the strengths and weaknesses of published SRs and reinforces the conclusion that DMEK leads to superior visual outcomes compared to UT-DSAEK, with the trade-off of higher rebubbling rates and possibly other postoperative complications. Studies with longer follow-up are needed to ascertain these differences between procedures.
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Affiliation(s)
- Nuno Moura-Coelho
- Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular (IMO) Barcelona Grupo Miranza, Barcelona, Spain
- NOVA Medical School (NMS) - Universidade Nova de Lisboa, Lisbon, Portugal
- European School for Advanced Studies in Ophthalmology (ESASO), Lugano, Switzerland
| | - Renato Papa-Vettorazzi
- Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular (IMO) Barcelona Grupo Miranza, Barcelona, Spain
- Anterior Segment Unit, Clínica Visualiza Guatemala, Guatemala, Guatemala
| | - Alonso Reyes
- Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular (IMO) Barcelona Grupo Miranza, Barcelona, Spain
| | - João Paulo Cunha
- Ophthalmology, Hospital CUF Cascais, Lisbon, Portugal
- Escola Superior de Tecnologia da Saúde de Lisboa (ESTeSL), Lisbon, Portugal
| | - José Luis Güell
- Cornea and Refractive Surgery Unit, Instituto de Microcirugía Ocular (IMO) Barcelona Grupo Miranza, Barcelona, Spain
- European School for Advanced Studies in Ophthalmology (ESASO), Lugano, Switzerland
- Ophthalmology, Universidad Autónoma de Barcelona, Barcelona, Spain
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Wang X, Wu T, Liu Z, Wang Y. Correlation of Dry Eye Disease and Laryngopharyngeal Reflux Based on Improved Symptoms With Combined Therapy. J Voice 2024:S0892-1997(24)00140-1. [PMID: 38763849 DOI: 10.1016/j.jvoice.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/16/2024] [Accepted: 04/16/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE To investigate the correlation between dry eye disease (DED) and laryngopharyngeal reflux (LPR) from the perspective of treatment response. STUDY DESIGN Cross-sectional studies. SETTING Analysis of data from patients with DED-related symptoms and LPR-related symptoms from May 2022 to January 2023 at AIER Eye Hospital (Hainan). METHODS The Ocular Surface Symptom Index (OSDI) scales and The Reflux Symptom Score (RSS) were investigated in patients attending China Aier Eye Hospital (Hainan) from May 2022 to January 2023, and OSDI scores >12 were categorized as DED, and RSS scores >13 were categorized as suspected laryngopharyngeal reflux (suspected LPR). Patients with DED and suspected LPR were randomly divided into three groups (group A: 0.3% sodium vitreous acid drops and 1% cyclosporine A drops only; group B: 0.3% sodium vitreous acid drops, 1% cyclosporine A drops, and Gastroftal tablets containing magnesium alginate and cimicifuga oil and esomeprazole; and group C: Gastroftal tablets and esomeprazole only orally) and were reviewed after 3 months for the RSS- and DED-related examinations. RESULT Two hundred and nineteen patients were enrolled. One hundred and ninety-one DED-positive and 28 DED-negative patients, 84 suspected LPR-positive and 135 LPR-negative patients, and the OSDI scores of LPR patients were significantly higher than those of LPR-negative patients (P < 0.001). Parameters related to DED and LPR were significantly lower in patients in group B than in groups A and C after treatment (P < 0.001). CONCLUSIONS LPR and DED are closely related. For patients with both LPR and DED, treating LPR and DED at the same time may be a better option.
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Affiliation(s)
- Xiaoyu Wang
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, Beijing 100048, China
| | - Tingting Wu
- AIER Eye Hospital (Hainan) Hospital, Haikou, Hainan Province 570100, China
| | - Zhi Liu
- Department of Otolaryngology, The Sixth Medical Center of PLA General Hospital of Beijing, Beijing, Beijing 100048, China
| | - Ying Wang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province 210000, China.
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McCann P, Kruoch Z, Lopez S, Malli S, Qureshi R, Li T. Interventions for Dry Eye: An Overview of Systematic Reviews. JAMA Ophthalmol 2024; 142:58-74. [PMID: 38127364 DOI: 10.1001/jamaophthalmol.2023.5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Importance Dry eye is a common ocular disease that can have substantial morbidity. Systematic reviews provide evidence for dry eye interventions and can be useful for patients, clinicians, and clinical guideline developers. Overviews of reviews use explicit and systematic methods to synthesize findings from multiple systematic reviews, but currently, there are no overviews of systematic reviews investigating interventions for dry eye. Objective To summarize the results of reliable systematic reviews of dry eye interventions and to highlight the evidence gaps identified. Evidence Review We searched the Cochrane Eyes and Vision US satellite database and included reliable systematic reviews evaluating dry eye interventions published from 2016 to 2022. We reported the proportion of systematic reviews that were reliable with reasons for unreliability. Critical and important outcomes from reliable systematic reviews were extracted and verified. Critical outcomes included dry eye-related patient-reported outcome measures. Results were synthesized from reliable systematic reviews to provide summaries of evidence for each intervention. Evidence for each intervention was defined as conclusive or inconclusive depending on whether high-certainty evidence across systematic reviews was available according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria and whether findings reached statistical or clinical significance. Recommendations were made for further research. Findings Within the Cochrane Eyes and Vision US satellite database, 138 potentially relevant systematic reviews were identified, 71 were considered eligible, and 26 (37%) were assessed as reliable. Among reliable systematic reviews, no conclusive evidence was identified for any dry eye intervention. Inconclusive evidence suggested that environmental modifications, dietary modifications, artificial tears and lubricants, punctal occlusion, intense pulsed light therapy, vectored thermal pulsation therapy (Lipiflow), topical corticosteroids, topical cyclosporine A, topical secretagogues, and autologous serum may be effective. Only unreliable systematic reviews evaluated lifitegrast, oral antibiotics, and moisture chamber devices. Conclusions and Relevance This overview of systematic reviews found some evidence that dry eye interventions may be effective, but no conclusive evidence was available. The conduct and reporting of most systematic reviews for dry eye interventions warrant improvement, and reliable systematic reviews are needed to evaluate lifitegrast, oral antibiotics, and moisture chamber devices.
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Affiliation(s)
- Paul McCann
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora
| | - Zanna Kruoch
- College of Optometry, Rocky Mountain University of Health Professions, Provo, Utah
| | - Sarah Lopez
- Francis I. Proctor Foundation, University of California, San Francisco
| | - Shreya Malli
- Department of Ophthalmology, University of California, San Francisco
| | - Riaz Qureshi
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora
- Department of Epidemiology, Colorado School of Public Health, Denver
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora
- Department of Epidemiology, Colorado School of Public Health, Denver
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Downie LE, Singh S, McGuinness MM. All That Glitters Is Not Gold: Interpreting Systematic Reviews and Meta-analyses with Case Studies from Ophthalmology - Part One. Ophthalmol Retina 2023; 7:465-467. [PMID: 37270262 DOI: 10.1016/j.oret.2023.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/05/2023]
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Downie LE, Britten-Jones AC, Hogg RE, Jalbert I, Li T, Lingham G, Liu SH, Qureshi R, Saldanha IJ, Singh S, Craig JP. TFOS Lifestyle - Evidence quality report: Advancing the evaluation and synthesis of research evidence. Ocul Surf 2023; 28:200-212. [PMID: 37054912 PMCID: PMC11246749 DOI: 10.1016/j.jtos.2023.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023]
Abstract
Evidence-based practice is a dominant paradigm in healthcare that emphasizes the importance of ensuring the translation of the best available, relevant research evidence into practice. An Evidence Quality Subcommittee was established to provide specialized methodological support and expertise to promote rigorous and evidence-based approaches for the Tear Film and Ocular Surface Society (TFOS) Lifestyle Epidemic reports. The present report describes the purpose, scope, and activity of the Evidence Quality Subcommittee in the undertaking of high-quality narrative-style literature reviews, and leading prospectively registered, reliable systematic reviews of high priority research questions, using standardized methods for each topic area report. Identification of predominantly low or very low certainty evidence across the eight systematic reviews highlights a need for further research to define the efficacy and/or safety of specific lifestyle interventions on the ocular surface, and to clarify relationships between certain lifestyle factors and ocular surface disease. To support the citation of reliable systematic review evidence in the narrative review sections of each report, the Evidence Quality Subcommittee curated topic-specific systematic review databases and relevant systematic reviews underwent standardized reliability assessment. Inconsistent methodological rigor was noted in the published systematic review literature, emphasizing the importance of internal validity assessment. Based on the experience of implementing the Evidence Quality Subcommittee, this report makes suggestions for incorporation of such initiatives in future international taskforces and working groups. Content areas broadly relevant to the activity of the Evidence Quality Subcommittee, including the critical appraisal of research, clinical evidence hierarchies (levels of evidence), and risk of bias assessment, are also outlined.
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Affiliation(s)
- Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia.
| | | | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Belfast, United Kingdom
| | | | - Tianjing Li
- Department of Ophthalmology and Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Gareth Lingham
- Centre for Eye Research Ireland, Technological University Dublin, Dublin, Ireland
| | - Su-Hsun Liu
- Department of Ophthalmology and Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Riaz Qureshi
- Department of Ophthalmology and Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ian J Saldanha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Sumeer Singh
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Fu Y, Mao Y, Jiang S, Luo S, Chen X, Xiao W. A bibliometric analysis of systematic reviews and meta-analyses in ophthalmology. Front Med (Lausanne) 2023; 10:1135592. [PMID: 36936241 PMCID: PMC10017479 DOI: 10.3389/fmed.2023.1135592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background Bibliometric analysis is a quantitative method which applies mathematical and statistical tools to evaluate the inter-relationships and impacts of publications, authors, institutions and countries in a specific research area. Systematic reviews and meta-analyses (SRMAs) are summaries of the best available evidence to address a specific research question via comprehensively literature search, in-depth analysis and synthesis of results. To date, there have been several studies summarizing the publication trends of SRMAs in research specialties, however, none has conducted specifically in ophthalmology. The purpose of this study is to establish the scientometric landscape of SRMAs published in the field of ophthalmology over time. Methods We retrieved relevant ophthalmological SRMAs and the corresponding bibliometric parameters during 2000 to 2020 from Web of Science Core Collection. Bibliometric analysis was performed using bibliometrix package. Pre-registration and guideline compliance of each article was independently assessed by two investigators. Results A total of 2,660 SRMAs were included, and the average annual growth rate was 21.26%. China and the United States were the most productive countries, while Singapore was the country with the highest average citations per document. Wong TY was not only the most productive, but also the most frequently cited author. The most productive affiliation was National University of Singapore (n = 236). Systematic reviews and meta-analyses output in most subspecialties had steadily increased with retina/vitreous (n = 986), glaucoma (n = 411) and cornea/external diseases (n = 303) constantly as the most dominant fields. Rates of pre-registration and guideline compliance had dramatically increased over time, with 20.0 and 63.5% of article being pre-registered and reported guideline in 2020, respectively. However, SRMAs published on ophthalmology journals tended to be less frequently pre-registered and guideline complied than those on non-ophthalmology journals (both p < 0.001). Conclusion The annual output of SRMAs has been rapidly increasing over the past two decades. China and the United States were the most productive countries, whereas Singapore has the most prolific and influential scholar and institution. Raising awareness and implementation of SRMAs pre-registration and guideline compliance is still necessary to ensure quality, especially for ophthalmology journals.
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Affiliation(s)
- Yihang Fu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Yuxiang Mao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Shuangyan Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Sheng Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
| | - Xiaoyun Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- *Correspondence: Wei Xiao, ; Xiaoyun Chen,
| | - Wei Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou, China
- *Correspondence: Wei Xiao, ; Xiaoyun Chen,
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McCann P, Kruoch Z, Qureshi R, Li T. Effectiveness of interventions for dry eye: a protocol for an overview of systematic reviews. BMJ Open 2022; 12:e058708. [PMID: 35672062 PMCID: PMC9174758 DOI: 10.1136/bmjopen-2021-058708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/13/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Dry eye is a leading cause of ocular morbidity and economic and societal burden for patients and healthcare systems. There are several treatment options available for dry eye and high-quality systematic reviews synthesise the evidence for their effectiveness and potential harms. METHODS AND ANALYSIS We will search the Cochrane Eyes and Vision US satellite (CEV@US) database of eyes and vision systematic reviews for systematic reviews on interventions for dry eye. CEV@US conducted an initial search of PubMed and Embase to populate the CEV@US database of eyes and vision systematic reviews in 2007, which was updated most recently in August 2021. We will search the database for systematic reviews published since 1 January 2016 because systematic reviews more than 5 years are unlikely to be up to date. We will consider Cochrane and non-Cochrane systematic reviews eligible for inclusion. Two authors will independently screen articles. We will include studies that evaluate interventions for dry eye and/or meibomian gland dysfunction with no restriction on types of participants or review language. We will select reliable systematic reviews (ie, those meeting pre-established methodological criteria) for inclusion, assessed by one investigator and verified by a second investigator. We will extract ratings of the certainty of evidence from within each review. We will report the degree of overlap for systematic reviews that answer similar questions and include overlapping primary studies. We will present results of the overview in alignment with guidelines in the Cochrane Handbook of Systematic Reviews of Interventions (Online Chapter 5: Overviews of Reviews), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and an overview of reviews quality and transparency checklist. The anticipated start and completion dates for this overview are 1 May 2021 and 30 April 2022, respectively. ETHICS AND DISSEMINATION This overview will not require the approval of an Ethics Committee because it will use published studies. We will publish results in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42021279880.
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Affiliation(s)
- Paul McCann
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Zanna Kruoch
- Cedar Springs Eye Clinic, College of Optometry, University of Houston, Houston, Texas, USA
| | - Riaz Qureshi
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
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Qureshi R, Azuara-Blanco A, Michelessi M, Virgili G, Barbosa Breda J, Cutolo CA, Pazos M, Katsanos A, Garhöfer G, Kolko M, Prokosch-Willing V, Al Rajhi AA, Lum F, Musch D, Gedde S, Li T. What Do We Really Know about the Effectiveness of Glaucoma Interventions?: An Overview of Systematic Reviews. Ophthalmol Glaucoma 2021; 4:454-462. [PMID: 33571689 PMCID: PMC8349936 DOI: 10.1016/j.ogla.2021.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/03/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To identify systematic reviews of interventions for glaucoma conditions and to assess their reliability, thereby generating a list of potentially reliable reviews for updating glaucoma practice guidelines. DESIGN Cross-sectional study. PARTICIPANTS Systematic reviews of interventions for glaucoma conditions. METHODS We used a database of systematic reviews and meta-analyses in vision research and eye care maintained by the Cochrane Eyes and Vision United States Satellite. We examined all Cochrane systematic reviews of interventions for glaucoma conditions published before August 7, 2019, and all non-Cochrane systematic reviews of interventions for glaucoma conditions published between January 1, 2014, and August 7, 2019. MAIN OUTCOME MEASURES We assessed eligible reviews for reliability, extracted characteristics, and summarized key findings from reviews classified as reliable. RESULTS Of the 4451 systematic reviews in eyes and vision identified, 129 met our eligibility criteria and were assessed for reliability. Of these, we classified 49 (38%) as reliable. We found open-angle glaucoma (22/49) to be the condition with the most reviews and medical management (17/49) and intraocular pressure (IOP; 43/49) to be the most common interventions and outcomes studied. Most reviews found a high degree of uncertainty in the evidence, which hinders the possibility of making strong recommendations in guidelines. These reviews found high-certainty evidence about a few topics: reducing IOP helps to prevent glaucoma and its progression, prostaglandin analogs are the most effective medical treatment for lowering IOP, laser trabeculoplasty is as effective as medical treatment as a first-line therapy in controlling IOP, the use of IOP-lowering medications in the perioperative or postoperative periods to accompany laser (e.g., trabeculoplasty) reduces the risk of postoperative IOP spikes, conventional surgery (i.e., trabeculectomy) is more effective than medications in reducing IOP, and antimetabolites and β-radiation improve IOP control after trabeculectomy. The evidence is weak regarding the effectiveness of minimally invasive glaucoma surgeries. CONCLUSIONS Most systematic reviews evaluating interventions for glaucoma are of poor reliability. Even among those that may be considered reliable, important limitations exist in the value of information because of the uncertainty of the evidence as well as small and sometimes unimportant clinical differences between interventions.
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Affiliation(s)
- Riaz Qureshi
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Augusto Azuara-Blanco
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | | | - Gianni Virgili
- Department of Neurosciences, Psychology Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - João Barbosa Breda
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal; and Research Group Ophthalmology, Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Carlo Alberto Cutolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Sciences, University of Genoa and IRCCS San Martino Policlinic Hospital, Genova, Italy
| | - Marta Pazos
- Department of Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Andreas Katsanos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | - Gerhard Garhöfer
- Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
| | - Miriam Kolko
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Glostrup, and Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - David Musch
- Departments of Ophthalmology and Visual Sciences and of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | | | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Denver, Aurora, Colorado.
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Le JT, Qureshi R, Twose C, Rosman L, Han G, Fapohunda K, Saldanha IJ, Scherer RW, Lum F, Al-Rajhi A, Musch DC, Hawkins BS, Dickersin K, Li T. Evaluation of Systematic Reviews of Interventions for Retina and Vitreous Conditions. JAMA Ophthalmol 2021; 137:1399-1405. [PMID: 31600387 DOI: 10.1001/jamaophthalmol.2019.4016] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Patient care and clinical practice guidelines should be informed by evidence from reliable systematic reviews. The reliability of systematic reviews related to forthcoming guidelines for retina and vitreous conditions is unknown. Objectives To summarize the reliability of systematic reviews on interventions for 7 retina and vitreous conditions, describe characteristics of reliable and unreliable systematic reviews, and examine the primary area in which they appeared to be lacking. Design, Setting, and Participants A cross-sectional study of systematic reviews was conducted. Systematic reviews of interventions for retina- and vitreous-related conditions in a database maintained by the Cochrane Eyes and Vision United States Satellite were identified. Databases that the reviewers searched, whether any date or language restrictions were applied, and bibliographic information, such as year and journal of publication, were documented. The initial search was conducted in March 2007, and the final update was performed in July 2018. The conditions of interest were age-related macular degeneration; diabetic retinopathy; idiopathic epiretinal membrane and vitreomacular traction; idiopathic macular hole; posterior vitreous detachment, retinal breaks, and lattice degeneration; retinal and ophthalmic artery occlusions; and retinal vein occlusions. The reliability of each review was evaluated using prespecified criteria. Data were extracted by 2 research assistants working independently, with disagreements resolved through discussion or by 1 research assistant with verification by a senior team member. Main Outcomes and Measures Proportion of reviews that meet all of the following criteria: (1) defined eligibility criteria for study selection, (2) described conducting a comprehensive literature search, (3) reported assessing risk of bias in included studies, (4) described using appropriate methods for any meta-analysis performed, and (5) provided conclusions consistent with review findings. Results A total of 327 systematic reviews that addressed retina and vitreous conditions were identified; of these, 131 reviews (40.1%) were classified as reliable and 196 reviews (59.9%) were classified as not reliable. At least 1 reliable review was found for each of the 7 retina and vitreous conditions. The most common reason that a review was classified as not reliable was lack of evidence that a comprehensive literature search for relevant studies had been conducted (149 of 196 reviews [76.0%]). Conclusion and Relevance The findings of this study suggest that most systematic reviews that addressed interventions for retina and vitreous conditions were not reliable. Systematic review teams and guideline developers should work with information professionals who can help navigate sophisticated and varied syntaxes required to search different resources.
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Affiliation(s)
- Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Riaz Qureshi
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claire Twose
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland
| | - Lori Rosman
- Welch Medical Library, Johns Hopkins University, Baltimore, Maryland
| | - Genie Han
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kolade Fapohunda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ian J Saldanha
- Department of Health Services, Policy, and Practice (Primary), Brown University School of Public Health, Providence, Rhode Island.,Department of Epidemiology (Joint), Brown University School of Public Health, Providence, Rhode Island
| | - Roberta W Scherer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Ali Al-Rajhi
- American Academy of Ophthalmology, San Francisco, California
| | - David C Musch
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | - Barbara S Hawkins
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Kay Dickersin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Tianjing Li
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Michelessi M, Li T, Miele A, Azuara-Blanco A, Qureshi R, Virgili G. Accuracy of optical coherence tomography for diagnosing glaucoma: an overview of systematic reviews. Br J Ophthalmol 2021; 105:490-495. [PMID: 32493760 PMCID: PMC7876780 DOI: 10.1136/bjophthalmol-2020-316152] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 01/06/2023]
Abstract
AIMS To assess the diagnostic accuracy (DTA) of optical coherence tomography (OCT) for detecting glaucoma by systematically searching and appraising systematic reviews (SRs) on this issue. METHODS We searched a database of SRs in eyes and vision maintained by the Cochrane Eyes and Vision United States on the DTA of OCT for detecting glaucoma. Two authors working independently screened the records, abstracted data and assessed the risk of bias using the Risk of Bias in Systematic Reviews checklist. We extracted quantitative DTA estimates as well as qualitative statements on their relevance to practice. RESULTS We included four SRs published between 2015 and 2018. These SRs included between 17 and 113 studies on OCT for glaucoma diagnosis. Two reviews were at low risk of bias and the other two had two to four domains at high or unclear risk of bias with concerns on applicability. The two reliable SRs reported the accuracy of average retinal nerve fibre layer (RNFL) thickness and found a sensitivity of 0.69 (0.63 to 0.73) and 0.78 (0.74 to 0.83) and a specificity of 0.94 (0.93 to 0.95) and 0.93 (0.92 to 0.95) in 57 and 50 studies, respectively. Only one review included a clear specification of the clinical pathway. Both reviews highlighted the limitations of primary DTA studies on this topic. CONCLUSIONS The quality of published DTA reviews on OCT for diagnosing glaucoma was mixed. Two reliable SRs found moderate sensitivity at high specificity for average RNFL thickness in diagnosing manifest glaucoma. Our overview suggests that the methodological quality of both primary and secondary DTA research on glaucoma is in need of improvement.
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Affiliation(s)
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alba Miele
- Eye Clinic, Department of NEUROFARBA, University of Florence, Florence, Italy
| | | | - Riaz Qureshi
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gianni Virgili
- Eye Clinic, Department of NEUROFARBA, University of Florence, Florence, Italy
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Bamahfouz AY, Alsaidi AA, Alharbi IJ, Elsebaei EA, Aldosari AM, Farahat AG, Alhazmi RT. Indolent keratitis due to fungus of Malbranchea species. A case report. Ann Med Surg (Lond) 2020; 60:606-609. [PMID: 33304572 PMCID: PMC7711076 DOI: 10.1016/j.amsu.2020.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Keratitis caused by saprophytic fungi is on the rise in rural areas, often caused by ocular trauma with wooden objects. Early detection of causative organisms and sustained, supervised management can prevent visual disabilities. Case presentation A middle-aged patient from a rural, semi-arid region who presented with pain, redness, and a foreign-body sensation in his left eye resulting from a corneal ulcer induced by trauma from a wooden stick. Due to a history of uncontrolled diabetes and progression of his corneal lesions, he was admitted to our institution for treatment of infectious keratitis. Microbiological examination of corneal scrapings revealed thin, septate hyaline hyphae without conidia or conidiophores, and the patient was diagnosed with a fungal keratitis caused by a Malbranchea species. Though the patient initially responded to treatment with topical natamycin, his condition worsened. He was subsequently successfully treated with topical amphotericin B (1 mg/mL) twice hourly and systemic antifungals. Four months after discharge, the patient returned with symptom recurrence. Conclusion We report the case of a patient with a Malbranchea species causing a rare and recurrent fungal keratitis with corneal infiltrates, subsequently cured by medical management with salvaging of his vision. In patients with a suspected fungal keratitis, early treatment is crucial and should be combined with tight glycemic control for as long as 6 months after presentation to avoid recurrence. Fungal keratitis can lead to visual disability if not treated adequately. Malbranchea species are rare pathogens resistant to many antifungal agents. Malbranchea keratitis treatment is difficult and can result in poor outcomes. Treating fungal keratitis is an indolent process often requiring months. Standard protocols are necessary for managing fungal keratitis.
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Colder Carras M, Shi J, Hard G, Saldanha IJ. Evaluating the quality of evidence for gaming disorder: A summary of systematic reviews of associations between gaming disorder and depression or anxiety. PLoS One 2020; 15:e0240032. [PMID: 33104730 PMCID: PMC7588081 DOI: 10.1371/journal.pone.0240032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 09/18/2020] [Indexed: 12/24/2022] Open
Abstract
Gaming disorder has been described as an urgent public health problem and has garnered many systematic reviews of its associations with other health conditions. However, review methodology can contribute to bias in the conclusions, leading to research, policy, and patient care that are not truly evidence-based. This study followed a pre-registered protocol (PROSPERO 2018 CRD42018090651) with the objective of identifying reliable and methodologically-rigorous systematic reviews that examine the associations between gaming disorder and depression or anxiety in any population. We searched PubMed and PsycInfo for published systematic reviews and the gray literature for unpublished systematic reviews as of June 24, 2020. Reviews were classified as reliable according to several quality criteria, such as whether they conducted a risk of bias assessment of studies and whether they clearly described how outcomes from each study were selected. We assessed possible selective outcome reporting among the reviews. Seven reviews that included a total of 196 studies met inclusion criteria. The overall number of participants was not calculable because not all reviews reported these data. All reviews specified eligibility criteria for studies, but not for outcomes within studies. Only one review assessed risk of bias. Evidence of selective outcome reporting was found in all reviews-only one review incorporated any of the null findings from studies it included. Thus, none were classified as reliable according to prespecified quality criteria. Systematic reviews related to gaming disorder do not meet methodological standards. As clinical and policy decisions are heavily reliant on reliable, accurate, and unbiased evidence synthesis; researchers, clinicians, and policymakers should consider the implications of selective outcome reporting. Limitations of the current summary include using counts of associations and restricting to systematic reviews published in English. Systematic reviewers should follow established guidelines for review conduct and transparent reporting to ensure evidence about technology use disorders is reliable.
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Affiliation(s)
| | - Jing Shi
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Hard
- MGH Institute of Health Professions, Mass General Brigham, Boston, Massachusetts, United States of America
| | - Ian J. Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy, and Practice, and Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America
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13
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Qureshi R, Han G, Fapohunda K, Abariga S, Wilson R, Li T. Authorship diversity among systematic reviews in eyes and vision. Syst Rev 2020; 9:192. [PMID: 32854764 PMCID: PMC7450569 DOI: 10.1186/s13643-020-01451-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE The inclusion of authors from diverse backgrounds and with different lived experiences is critical to ensuring the questions addressed in systematic reviews (SRs), as well as the subsequent conclusions and recommendations made, are representative of the global community. OBJECTIVE To assess the gender and geographic diversity of authors among all Cochrane SRs in eyes and vision as compared with a random sample of non-Cochrane SRs of interventions in the field of eyes and vision. DESIGN The Cochrane Eyes and Vision US Satellite maintains a database of SRs in the field of eyes and vision. We selected all (n = 313) eyes and vision intervention SRs published in The Cochrane Library and a random sample of 313 eyes and vision intervention SRs published elsewhere for this study. We determined gender of the first and corresponding authors ("woman," "man," or "unknown") using a previously developed algorithm and their location based on institution country and the World Health Organization region. RESULTS From the 626 reviews included in our sample, we identified 751 unique authors who comprised 887 author positions (i.e., first and/or corresponding authors). We were able to ascertain the gender of 647/751 (86%) authors: 276 women and 371 men. Among Cochrane eyes and vision SRs, the proportions of women in first and/or corresponding author positions were consistent and approximately equal to men. Among non-Cochrane eyes and vision SRs, the representation of women was markedly lower as corresponding authors than other positions. Most authors of Cochrane eyes and vision SRs were from the UK (31%) and USA (26%), whereas most authors of non-Cochrane SRs were from China (34%). CONCLUSIONS AND RELEVANCE Compared with authors of non-Cochrane SRs in eyes and vision, authors of Cochrane SRs appear to have approximately equal representation of women and men among perceived important author positions and be located in European and North American countries, possibly due to the locations of the Cochrane editorial teams. Cochrane Eyes and Vision should continue to recruit authors from around the world in locations that reflect the global burden of eye disease.
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Affiliation(s)
- Riaz Qureshi
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Genie Han
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Kolade Fapohunda
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Samuel Abariga
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, 1675 Aurora Ct. F731, Aurora, CO 80045 USA
| | - Renee Wilson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, 1675 Aurora Ct. F731, Aurora, CO 80045 USA
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Pepose JS, Foulks GN, Nelson JD, Erickson S, Lemp MA. Perspective on Systematic Medical Literature Reviews and Meta-Analyses. Am J Ophthalmol 2020; 211:15-21. [PMID: 31811861 DOI: 10.1016/j.ajo.2019.11.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE This study sought to identify factors contributing to the inadequacies of systematic reviews and meta-analyses (SRMAs) published in the ophthalmology literature. DESIGN Perspective. METHODS Review and synthesis of selective literature, with interpretation and perspective. RESULTS Although recommendations for the design, conduct, assessment of quality, and risk of bias of systematic reviews have been widely available, some recent publications illustrate a serious potential failing in this domain: inclusion of refuted science, lack of citation of post-publication correspondence and failure to use ≥1 alternative search strategy. CONCLUSIONS Examples of inadequacies of peer review in medical literature and perpetuation of erroneous science by unfiltered inclusion in subsequent systematic reviews have been identified, and the problem can be traced to authors, peer reviewers, and editors of journals. This perspective identifies and analyzes several possible causes of the problem and recommends some specific corrective actions to improve the quality and accuracy of such reviews.
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15
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Saldanha IJ, Smith BT, Ntzani E, Jap J, Balk EM, Lau J. The Systematic Review Data Repository (SRDR): descriptive characteristics of publicly available data and opportunities for research. Syst Rev 2019; 8:334. [PMID: 31862012 PMCID: PMC6925515 DOI: 10.1186/s13643-019-1250-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 12/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Conducting systematic reviews ("reviews") requires a great deal of effort and resources. Making data extracted during reviews available publicly could offer many benefits, including reducing unnecessary duplication of effort, standardizing data, supporting analyses to address secondary research questions, and facilitating methodologic research. Funded by the US Agency for Healthcare Research and Quality (AHRQ), the Systematic Review Data Repository (SRDR) is a free, web-based, open-source, data management and archival platform for reviews. Our specific objectives in this paper are to describe (1) the current extent of usage of SRDR and (2) the characteristics of all projects with publicly available data on the SRDR website. METHODS We examined all projects with data made publicly available through SRDR as of November 12, 2019. We extracted information about the characteristics of these projects. Two investigators extracted and verified the data. RESULTS SRDR has had 2552 individual user accounts belonging to users from 80 countries. Since SRDR's launch in 2012, data have been made available publicly for 152 of the 735 projects in SRDR (21%), at a rate of 24.5 projects per year, on average. Most projects are in clinical fields (144/152 projects; 95%); most have evaluated interventions (therapeutic or preventive) (109/152; 72%). The most frequent health areas addressed are mental and behavioral disorders (31/152; 20%) and diseases of the eye and ocular adnexa (23/152; 15%). Two-thirds of the projects (104/152; 67%) were funded by AHRQ, and one-sixth (23/152; 15%) are Cochrane reviews. The 152 projects each address a median of 3 research questions (IQR 1-5) and include a median of 70 studies (IQR 20-130). CONCLUSIONS Until we arrive at a future in which the systematic review and broader research communities are comfortable with the accuracy of automated data extraction, re-use of data extracted by humans has the potential to help reduce redundancy and costs. The 152 projects with publicly available data through SRDR, and the more than 15,000 studies therein, are freely available to researchers and the general public who might be working on similar reviews or updates of reviews or who want access to the data for decision-making, meta-research, or other purposes.
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Affiliation(s)
- Ian J Saldanha
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA.
- Department of Epidemiology, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA.
| | - Bryant T Smith
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA
| | - Evangelia Ntzani
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Jens Jap
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA
| | - Ethan M Balk
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA
| | - Joseph Lau
- Department of Health Services, Policy, and Practice, Center for Evidence Synthesis in Health, Brown University School of Public Health, 121 South Main Street, Box G-S121-8, Providence, RI, 02903, USA
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