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Ghozy S, El-Qushayri AE, Gbreel MI, Farahat RA, Azzam AY, Elfil M, Kobeissi H, Dmytriw A, Al-Mufti F, Kadirvel R, Kallmes DF. The impact of funding on the quality and interpretation of systematic reviews of mechanical thrombectomy in stroke patients. Interv Neuroradiol 2022:15910199221145741. [PMID: 36852503 DOI: 10.1177/15910199221145741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Funding may impact the quality and findings of systematic reviews (SRs). We aimed to compare the methodological quality of funded and non-funded SRs that investigated the outcomes in ischemic stroke patients undergoing mechanical thrombectomy. METHODS We conducted a comprehensive search strategy in different databases, including Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline (including epub ahead of print, in-process & other non-indexed citations), PubMed, Scopus and Web of Science Core Collection to retrieve all relevant SRs. Random sequence generation matched each funded SR with a non-funded one. A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2 tool was used to assess the bias and quality of the included SRs. We also used uni- and multivariate analysis to perform our analysis, and results were expressed in odds ratio (OR) and 95% confidence interval (CI). RESULTS We retrieved 150 articles, which were randomized and matched into 100 SRs, including 50 funded and 50 non-funded studies. By multivariate analysis, we found that including randomized clinical trials (RCTs) (OR: 5.7; 95% CI: 1.8-17.8; p = 0.003) and reporting conflict of interests (OR: 5.2; 95 CI: 1.1-24; p = 0.036) were the only significant differences between funded and non-funded SRs. No significant differences were found regarding the overall confidence for low-quality (OR: 0.54; 95% CI: 0.09-3.2; p = 0.49) and moderate/high-quality SRs (OR: 0.17; 95% CI: 0.02-1.87; p = 0.14). CONCLUSION Funded studies tend to include RCTs more often and report conflict of interests with no significant impact on overall confidence.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
- Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (EBHC program), 6396Oxford University, Oxford, UK
| | | | | | | | | | - Mohamed Elfil
- Department of Neurological Sciences, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | - Hassan Kobeissi
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
| | - Adam Dmytriw
- Neurointerventional Program, Departments of Medical Imaging and Clinical Neurological Sciences, London Health Sciences Centre, 6221Western University, London, Ontario, Canada
- Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Ramanathan Kadirvel
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, 6915Mayo Clinic, Rochester, MN, USA
| | - David F Kallmes
- Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA
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Okoli GN, Lam OLT, Reddy VK, Al-Yousif Y, Racovitan F, Askin N. An overview of the characteristics and methodological standards across systematic reviews with Meta-analysis of efficacy/effectiveness of influenza antiviral drugs. Curr Med Res Opin 2022; 38:2035-2046. [PMID: 35819250 DOI: 10.1080/03007995.2022.2100655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Influenza antiviral drugs remain controversial and it is not clear if conclusions on their efficacy/effectiveness are based on high quality systematic reviews (SRs). We systematically identified, critically appraised, and summarized the characteristics and adherence to methodological standards in SRs with meta-analysis of efficacy/effectiveness of influenza antiviral drugs for prevention and/or treatment of influenza. METHODS We searched MEDLINE, Embase, Scopus, CINAHL, Global Health, and CDSR for English-language SR publications up to July 2020. We summarized the characteristics, adherence to methodological standards and SR quality (AMSTAR 2). RESULTS From a total 3,898 citations after removal of duplicates from all identified citations, we included 24 SRs. Seventy-five percent (n = 18) were of a critically low quality, 8% (n = 2) of a low quality, 17% (n = 4) of a moderate quality, and none were of a high quality. Seventeen percent (n = 4) were industry-funded, 4% (n = 1) coauthored by industry employee(s), and 33% (n = 8) commissioned by an organization or authority. Only 33% percent (n = 8) reported protocol registration, 4% (n = 1) reported collaboration with a knowledge synthesis librarian/information specialist, and 17% (n = 4) utilized a systematic review reporting checklist. CONCLUSIONS The evidence suggests that SRs of efficacy/effectiveness of influenza antiviral drugs are mostly of critically low quality and do not follow current best SR practices. These findings are significant in view of the important role of SRs in decision-making and the controversies that surround the use of the influenza antiviral drugs. However, the findings should not be interpreted to mean curtailment/cessation of use of antiviral drugs for influenza.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Otto L T Lam
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Viraj K Reddy
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Yahya Al-Yousif
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
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Okoli GN, Reddy VK, Lam OLT, Racovitan F, Al-Yousif Y, Askin N. Characteristics and methodological standards across systematic reviews with Meta-analysis of efficacy and/or effectiveness of influenza vaccines: an overview of reviews. Infect Dis (Lond) 2022; 54:861-880. [PMID: 36000220 DOI: 10.1080/23744235.2022.2114537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND While systematic reviews (SR) generally suggest that vaccination is an effective way to prevent influenza infection, it is not clear if these conclusions are based on high quality SR methods. As such, we systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in SRs with meta-analysis of efficacy/effectiveness of influenza vaccines. METHODS We searched MEDLINE, Embase, Scopus, CINAHL, Global Health, and CDSR for English-language SR publications up to July 11, 2022. We summarised the characteristics, adherence to methodological standards and SR quality (AMSTAR 2). RESULTS From 11,193 retrieved citations, we included 48 publications (47 SRs). Seventy-five percent were of a critically low quality, 19% of a low quality, 2% of a moderate quality, and 4% of a high quality. Thirteen percent were industry-funded, about 13% co-authored by industry employee(s), and 4% commissioned by an organisation or authority. Only 45% percent reported protocol registration, 6% reported collaboration with a knowledge synthesis librarian/information specialist, and 60% utilised a reporting checklist (e.g. PRISMA). CONCLUSIONS AND RELEVANCE SRs with meta-analysis of efficacy/effectiveness of influenza vaccines are mostly of critically low quality and even the more recent reviews did not follow current best SR practices. These findings are significant in view of the controversies that surround influenza vaccines, and the use of SRs in informed decision-making. However, the findings do not justify curtailment or cessation of influenza vaccine use as vaccines continue to offer substantial net public health benefit.HighlightsWe systematically identified, critically appraised, and summarised the characteristics and adherence to methodological standards in 47 systematic reviews with meta-analysis of efficacy/effectiveness of influenza vaccines.13% of the reviews were industry-funded.About 13% of the reviews were co-authored by industry employee(s).4% of the reviews were commissioned by an organisation/authority.45% of the reviews reported protocol registration.6% of the reviews reported collaborating with a knowledge synthesis librarian/information specialist to prepare the search strategy.60% of the reviews reported using the PRISMA (or similar) checklist.75% of the reviews were judged to be of critically low quality; 19% of low quality; 2% of moderate quality; 4% of high quality.
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Affiliation(s)
- George N Okoli
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Vaccine and Drug Evaluation Centre, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Viraj K Reddy
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Otto L T Lam
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Florentin Racovitan
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yahya Al-Yousif
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Askin
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada
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Pieper D, Hellbrecht I, Zhao L, Baur C, Pick G, Schneider S, Harder T, Young K, Tricco AC, Westhaver E, Tunis M. Impact of industry sponsorship on the quality of systematic reviews of vaccines: a cross-sectional analysis of studies published from 2016 to 2019. Syst Rev 2022; 11:174. [PMID: 35996186 PMCID: PMC9395849 DOI: 10.1186/s13643-022-02051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Systematic reviews (SRs) provide the highest level of evidence and inform evidence-based decision making in health care. Earlier studies found association with industry to be negatively associated with methodological quality of SRs. However, this has not been investigated in SRs on vaccines. METHODS We performed a systematic literature search using MEDLINE and EMBASE in March 2020. The results were restricted to those published between 2016 and 2019 with no language restrictions. Study characteristics were extracted by one person and checked by an experienced reviewer. The methodological quality of the SRs was assessed with the AMSTAR 2 tool by multiple reviewers after a calibration exercise was performed. A summary score for each SR was calculated. The Mann-Whitney U test and Fisher's exact test were performed to compare both groups. RESULTS Out of 185 SRs that met all inclusion criteria, 27 SRs were industry funded. Those were matched with 30 non-industry funded SRs resulting in a total sample size of 57. The mean AMSTAR 2 summary score across all SRs was 0.49. Overall, the median AMSTAR 2 summary score was higher for the non-industry funded SRs than for the industry-funded SRs (0.62 vs. 0.36; p < .00001). Lower ratings for industry funded SRs were consistent across all but one AMSTAR 2 item, though significantly lower only for three specific items. CONCLUSION The methodological quality of SRs in vaccination is comparable to SRs in other fields, while it is still suboptimal. We are not able to provide a satisfactory explanation why industry funded SRs had a lower methodological quality than non-industry funded SRs over recent years. Industry funding is an important indicator of methodological quality for vaccine SRs and should be carefully considered when appraising SR quality.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany. .,Faculty of Health Sciences Brandenburg, Brandenburg Medical School (Theodor Fontane), Institute for Health Services and Health System Research, Rüdersdorf, Germany. .,Center for Health Services Research, Brandenburg Medical School (Theodor Fontane), Rüdersdorf, Germany.
| | - Irma Hellbrecht
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Linlu Zhao
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Clemens Baur
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Georgia Pick
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | - Sarah Schneider
- Institute for Research in Operative Medicine, Evidence-Based Health Services Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, building 38, 51109, Cologne, Germany.,Institute of Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany
| | | | - Kelsey Young
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Epidemiology Division of the Dalla Lana School of Public Health and the Institute for Health, University of Toronto, Toronto, Ontario, Canada.,Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingsto, Ontario, Canada
| | - Ella Westhaver
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Matthew Tunis
- Health Canada and Public Health Agency of Canada, Ottawa, Ontario, Canada
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Storman D, Koperny M, Zając J, Polak M, Weglarz P, Bochenek-Cibor J, Swierz MJ, Staskiewicz W, Gorecka M, Skuza A, Wach AA, Kaluzinska K, Bała MM. Predictors of Higher Quality of Systematic Reviews Addressing Nutrition and Cancer Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010506. [PMID: 35010766 PMCID: PMC8744691 DOI: 10.3390/ijerph19010506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/15/2021] [Accepted: 12/26/2021] [Indexed: 02/04/2023]
Abstract
Systematic reviews/meta-analyses (SR/MAs) are considered a reliable source of information in healthcare. We aimed to explore the association of several characteristics of SR/MAs addressing nutrition in cancer prevention and their quality/risk of bias (using assessments from AMSTAR-2 and ROBIS tools). The analysis included 101 SR/MAs identified in a systematic survey. Associations of each specified characteristic (e.g., information about the protocol, publication year, reported use of GRADE, or other methods for assessing overall certainty of evidence) with the number of AMSTAR-2 not met (‘No’ responses) and the number of ROBIS items met (‘Probably Yes’ or “Yes’ responses) were examined. Poisson regression was used to identify predictors of the number of ‘No’ answers (indicating lower quality) for all AMSTAR-2 items and the number of ‘Yes’ or ‘Probably Yes’ answers (indicating higher quality/lower concern for bias) for all ROBIS items. Logistic regression was used to identify variables associated with at least one domain assessed as ‘low concern for bias’ in the ROBIS tool. In multivariable analysis, SR/MAs not reporting use of any quality/risk of bias assessment instrument for primary studies were associated with a higher number of ‘No’ answers for all AMSTAR-2 items (incidence rate ratio (IRR) 1.26, 95% confidence interval (CI) 1.09–1.45), and a lower number of ‘Yes’ or ‘Probably Yes’ answers for all ROBIS items (IRR 0.76, 95% CI 0.66–0.87). Providing information about the protocol and search for unpublished studies was associated with a lower number of ‘No’ answers (IRR 0.73, 95% CI 0.56–0.97 and IRR 0.75, 95% CI 0.59–0.95, respectively) and a higher number of ‘Yes’ or ‘Probably Yes’ answers (IRR 1.43, 95% CI 1.17–1.74 and IRR 1.28, 95% CI 1.07–1.52, respectively). Not using at least one quality/risk of bias assessment tool for primary studies within an SR/MA was associated with lower odds that a study would be assessed as ‘low concern for bias’ in at least one ROBIS domain (odds ratio 0.061, 95% CI 0.007–0.527). Adherence to methodological standards in the development of SR/MAs was associated with a higher overall quality of SR/MAs addressing nutrition for cancer prevention.
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Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Joanna Zając
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-034 Krakow, Poland;
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | | | - Mateusz J. Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
| | - Wojciech Staskiewicz
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Magdalena Gorecka
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Anna Skuza
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Adam A. Wach
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Klaudia Kaluzinska
- Students’ Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, 31-034 Krakow, Poland; (W.S.); (M.G.); (A.S.); (A.A.W.); (K.K.)
| | - Małgorzata M. Bała
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland; (D.S.); (J.Z.); (P.W.); (M.J.S.)
- Correspondence:
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Wu IX, Wang H, Zhu L, Chen Y, Wong CH, Mao C, Chung VC. Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study. Ther Adv Musculoskelet Dis 2020; 12:1759720X20959967. [PMID: 33014149 PMCID: PMC7518002 DOI: 10.1177/1759720x20959967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/29/2020] [Indexed: 12/13/2022] Open
Abstract
Background Healthcare providers need reliable evidence for supporting the adoption of new interventions, of which the source of evidence often originates from systematic reviews (SRs). However, little assessment on the rigor of SRs related to osteoarthritis interventions has been conducted. This cross-sectional study aimed to evaluate the methodological quality and predictors among SRs on osteoarthritis interventions. Methods Four electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, and PsycINFO) were searched, from 1 January 2008 to 10 October 2019. An SR was eligible if it focused on osteoarthritis interventions, and we performed at least one meta-analysis. Methodological quality was assessed using the validated AMSTAR 2 instrument. Multivariate regression analyses were conducted to assess predictors of methodological quality. Results In total, 167 SRs were included. The most SRs were non-Cochrane reviews (88.6%), and 54.5% investigated non-pharmacological interventions. Only seven (4.2%) had high methodological quality. Respectively, eight (4.8%), 25 (15.0%), and 127 (76.0%) SRs had moderate, low, and critically low quality. Main methodological weaknesses were as follows: only 16.8% registered protocol a priori, 4.2% searched literature comprehensively, 25.7% included lists of excluded studies with justifications, and 30.5% assessed risk of bias appropriately by considering allocation concealment, blinding of patients and assessors, random sequence generation and selective reported outcomes. Cochrane reviews [adjusted odds ratio (AOR) 251.5, 95% confidence interval (CI) 35.5-1782.6], being updates of previous SRs (AOR 3.9, 95% CI 1.1-13.7), and SRs published after 2017 (AOR 7.7, 95% CI 2.8-21.5) were positively related to higher methodological quality. Conclusion Despite signs of improvement in recent years, most of the SRs on osteoarthritis interventions have critically low methodological quality, especially among non-Cochrane reviews. Future SRs should be improved by conducting comprehensive literature search, justifying excluded studies, publishing a protocol, and assessing the risk of bias of included studies appropriately.
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Affiliation(s)
- Irene Xy Wu
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Huan Wang
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Lin Zhu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Yancong Chen
- Xiangya School of Public Health, Central South University, Changsha, China
| | - Charlene Hl Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Rm 509, 5/F, Prince of Wales Hospital, Shatin, Hong Kong 999077, Hong Kong
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Vincent Ch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Haddiya I. Current Knowledge of Vaccinations in Chronic Kidney Disease Patients. Int J Nephrol Renovasc Dis 2020; 13:179-185. [PMID: 32801834 PMCID: PMC7394503 DOI: 10.2147/ijnrd.s231142] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 07/03/2020] [Indexed: 12/11/2022] Open
Abstract
Chronic kidney disease (CKD) patients are at high risk for infectious complications. This is partly due to their dysfunctional immune system, especially in advanced CKD stages. Vaccination represents an important prevention strategy in these patients, as several studies have reported lower infection rates and significantly reduced morbidity and mortality in hospitals adopting vaccination protocols. However, vaccination rates are particularly low in these patients, and the diminished immune responsiveness remains the main issue of vaccination in CKD patients. Besides, there are various immunization protocols across the world in the absence of optimal vaccination policies. This paper aims to discuss the current knowledge of vaccination in this immunocompromised group of patients based on recent evidence and recommendations.
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Affiliation(s)
- Intissar Haddiya
- Department of Nephrology, Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, University Mohamed Premier, Oujda, Morocco
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Abstract
OBJECTIVES There is an increasing prevalence of hypothyroidism and there is a growing body of meta-analyses (MAs) on the association between hypothyroidism and other diseases. However, the methodological quality of the MAs significantly varies. Thus, this study aimed to evaluate and summarise data on the methodological quality of MAs on the associations between hypothyroidism and other diseases using the Assessment of Multiple Systematic Reviews (AMSTAR) scale, providing suggestions for clinical decision-making processes. DESIGN To assess the methodological quality of MAs using the AMSTAR scale. DATA SOURCES A systematic literature search was performed in PubMed, EMBASE, the Cochrane Library, web of science and Chinese Biomedicine Literature Database. ELIGIBILITY CRITERIA We included MAs that had assessed the association between hypothyroidism and other diseases in humans and that had full texts regardless of the publication status. No restriction applied on language or date. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened the titles and abstracts of all searched literature to acquire potentially eligible publications. The full texts of possible eligible publications were downloaded and assessed. Inconsistent comments were resolved through discussions with a third reviewer. RESULTS 52 studies were included. The average AMSTAR score of the included articles was 8.6 (range: 5-10), and those of English and Chinese MAs were 8.8 and 7.0, respectively. A total of 52 MAs were evaluated, and 19 (36.5%) and 33 (63.5%) of these MAs were of moderate and high quality, respectively. None of the MAs were of low quality. Only two MAs had an a priori design. Items 3, 5 and 9 had the highest compliance (50/52, 96.2%), and aside from item 1, items 7 and 8 had the lowest compliance (33/52,63.5%). According to the results of these MAs, hypothyroidism was significantly associated with cardiovascular diseases, metabolic diseases, neuropsychiatric disorders, breast cancer and pregnancy outcome. CONCLUSIONS The methodological quality of the included MAs on the association between hypothyroidism and other diseases was moderate to high. MAs with high qualities confirmed that hypothyroidism was significantly associated with cardiovascular diseases, metabolic syndrome, preterm birth and neonatal outcomes. Consideration of scientific quality when formulating conclusions should be made explicit and more attention should be paid to improving the methodological quality of MAs, and increasing their applicability for clinical decision-making.
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Affiliation(s)
- Limin Tian
- School of Medicine, Lanzhou University, Lanzhou, China
- Department of Endocrinology (cadre ward 3), Gansu Provincial Hospital, Lanzhou, China
- Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou, China
| | - Feifei Shao
- Department of Endocrinology (cadre ward 3), Gansu Provincial Hospital, Lanzhou, China
- Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou, China
| | - Yahong Qin
- Department of Endocrinology (cadre ward 3), Gansu Provincial Hospital, Lanzhou, China
- Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou, China
| | - Qian Guo
- Department of Endocrinology (cadre ward 3), Gansu Provincial Hospital, Lanzhou, China
- Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou, China
| | - Cuixia Gao
- Clinical Research Center for Metabolic Diseases, Gansu Provincial Hospital, Lanzhou, China
- Department of Ultrasonic Diagnosis, Gansu Provincial Hospital, Lanzhou, China
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Methodological quality of systematic reviews on treatments for depression: a cross-sectional study. Epidemiol Psychiatr Sci 2018; 27:619-627. [PMID: 28462754 PMCID: PMC6998998 DOI: 10.1017/s2045796017000208] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS Depression is one of the most common mental disorders and identifying effective treatment strategies is crucial for the control of depression. Well-conducted systematic reviews (SRs) and meta-analyses can provide the best evidence for supporting treatment decision-making. Nevertheless, the trustworthiness of conclusions can be limited by lack of methodological rigour. This study aims to assess the methodological quality of a representative sample of SRs on depression treatments. METHODS A cross-sectional study on the bibliographical and methodological characteristics of SRs published on depression treatments trials was conducted. Two electronic databases (the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects) were searched for potential SRs. SRs with at least one meta-analysis on the effects of depression treatments were considered eligible. The methodological quality of included SRs was assessed using the validated AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool. The associations between bibliographical characteristics and scoring on AMSTAR items were analysed using logistic regression analysis. RESULTS A total of 358 SRs were included and appraised. Over half of included SRs (n = 195) focused on non-pharmacological treatments and harms were reported in 45.5% (n = 163) of all studies. Studies varied in methods and reporting practices: only 112 (31.3%) took the risk of bias among primary studies into account when formulating conclusions; 245 (68.4%) did not fully declare conflict of interests; 93 (26.0%) reported an 'a priori' design and 104 (29.1%) provided lists of both included and excluded studies. Results from regression analyses showed: more recent publications were more likely to report 'a priori' designs [adjusted odds ratio (AOR) 1.31, 95% confidence interval (CI) 1.09-1.57], to describe study characteristics fully (AOR 1.16, 95% CI 1.06-1.28), and to assess presence of publication bias (AOR 1.13, 95% CI 1.06-1.19), but were less likely to list both included and excluded studies (AOR 0.86, 95% CI 0.81-0.92). SRs published in journals with higher impact factor (AOR 1.14, 95% CI 1.04-1.25), completed by more review authors (AOR 1.12, 95% CI 1.01-1.24) and SRs on non-pharmacological treatments (AOR 1.62, 95% CI 1.01-2.59) were associated with better performance in publication bias assessment. CONCLUSION The methodological quality of included SRs is disappointing. Future SRs should strive to improve rigour by considering of risk of bias when formulating conclusions, reporting conflict of interests and authors should explicitly describe harms. SR authors should also use appropriate methods to combine the results, prevent language and publication biases, and ensure timely updates.
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Jamshidi L, Heyvaert M, Declercq L, Fernández-Castilla B, Ferron JM, Moeyaert M, Beretvas SN, Onghena P, Van den Noortgate W. Methodological quality of meta-analyses of single-case experimental studies. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 79:97-115. [PMID: 29289406 DOI: 10.1016/j.ridd.2017.12.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/31/2017] [Accepted: 12/13/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Methodological rigor is a fundamental factor in the validity and credibility of the results of a meta-analysis. AIM Following an increasing interest in single-case experimental design (SCED) meta-analyses, the current study investigates the methodological quality of SCED meta-analyses. METHODS AND PROCEDURES We assessed the methodological quality of 178 SCED meta-analyses published between 1985 and 2015 through the modified Revised-Assessment of Multiple Systematic Reviews (R-AMSTAR) checklist. OUTCOMES AND RESULTS The main finding of the current review is that the methodological quality of the SCED meta-analyses has increased over time, but is still low according to the R-AMSTAR checklist. A remarkable percentage of the studies (93.80% of the included SCED meta-analyses) did not even reach the midpoint score (22, on a scale of 0-44). The mean and median methodological quality scores were 15.57 and 16, respectively. Relatively high scores were observed for "providing the characteristics of the included studies" and "doing comprehensive literature search". The key areas of deficiency were "reporting an assessment of the likelihood of publication bias" and "using the methods appropriately to combine the findings of studies". CONCLUSIONS AND IMPLICATIONS Although the results of the current review reveal that the methodological quality of the SCED meta-analyses has increased over time, still more efforts are needed to improve their methodological quality.
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Affiliation(s)
- Laleh Jamshidi
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium; IMEC-ITEC, KU Leuven, University of Leuven, Belgium.
| | - Mieke Heyvaert
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium
| | - Lies Declercq
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium; IMEC-ITEC, KU Leuven, University of Leuven, Belgium
| | - Belén Fernández-Castilla
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium; IMEC-ITEC, KU Leuven, University of Leuven, Belgium
| | | | | | | | - Patrick Onghena
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium
| | - Wim Van den Noortgate
- Faculty of Psychology and Educational Sciences, KU Leuven, University of Leuven, Belgium; IMEC-ITEC, KU Leuven, University of Leuven, Belgium
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Kosmadakis G, Albaret J, Correia EDC, Somda F, Aguilera D. Vaccination practices in dialysis patients: A narrative review. Semin Dial 2018; 31:507-518. [PMID: 29742283 DOI: 10.1111/sdi.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In a period of turmoil concerning vaccination practices, there is a serious conflict between scientifically reasonable, evidence-based guidelines and the far-fetched rumors or misconceptions concerning the vaccination practices in the general population. When a significant portion of the medical and paramedical personnel may be deliberately unvaccinated against common biological agents, achieving effective vaccination rates in the dialysis population may be complicated. Vaccination rates are unacceptably low in dialysis patients and seroconversion rates are even lower; further, serological follow-up is generally poor. The particularly anergic immune system of the advanced chronic kidney disease patients is partly a cause of both high rates of infection and low rates of seroconversions. This narrative review is an effort to summarize current knowledge concerning the vaccination practices in dialysis patients with some specific recommendations based on these facts. Of particular interest is a new vaccine, the Zoster Recombinant, Adjuvanted Vaccine (Shingrix), which we will include in our discussion.
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Affiliation(s)
- Georges Kosmadakis
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Julie Albaret
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | | | - Frederic Somda
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
| | - Didier Aguilera
- Hemodialyis Unit and Pole Metabolique, Centre Hospitalier Jacques Lacarin, Vichy, France
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Pieper D, Waltering A, Holstiege J, Büchter RB. Quality ratings of reviews in overviews: a comparison of reviews with and without dual (co-)authorship. Syst Rev 2018; 7:63. [PMID: 29690911 PMCID: PMC5916723 DOI: 10.1186/s13643-018-0722-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 03/26/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Previous research shows that many authors of Cochrane overviews were also involved in some of the included systematic reviews (SRs). This type of dual (co-)authorship (DCA) may be a conflict of interest and a potential source of bias. Our objectives were to (1) additionally investigate DCA in non-Cochrane overviews; (2) investigate whether there is an association between DCA and quality assessments of SRs in Cochrane and non-Cochrane overviews. METHODS We selected a sample of Cochrane (n = 20) and non-Cochrane (n = 78) overviews for analysis. We extracted data on the number of reviews affected by DCA and whether quality assessment of included reviews was conducted independently. Differences in mean quality scores between SRs with and without DCA were calculated in each overview. These differences were standardized (using the standardized mean difference (SMD)) and meta-analyzed using a random effects model. RESULTS Forty out of 78 non-Cochrane overviews (51%) and 18 out of 20 Cochrane overviews (90%) had included at least one SR with DCA. For Cochrane overviews, a median of 5 [interquartile range (IQR) 2.5 to 7] SRs were affected by DCA (median of included reviews 10). For non-Cochrane overviews a median of 1 [IQR 0 to 2] of the included SRs were affected (median of included reviews 14). The meta-analysis showed a SMD of 0.58 (95% confidence interval (CI) 0.27 to 0.90) indicating higher quality scores in reviews with overlapping authors. The test for subgroup differences shows no evidence of a difference between Cochrane (SMD 0.44; 95% CI 0.07 to 0.81) and non-Cochrane overviews (SMD 0.62; 95% CI 0.06 to 1.17). CONCLUSIONS Many authors of overviews also often have an authorship on one or more of the underlying reviews. Our analysis shows that, on average, authors of overviews give higher quality ratings to SRs in which they were involved themselves than to other SRs. Conflict of interest is one explanation, but there are several others such as reviewer expertise. Independent and blinded reassessments of the reviews would provide more robust evidence on potential bias arising from DCA.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine, Witten/Herdecke University, Ostmerheimer Str. 200 (Building 38), 51109, Cologne, Germany.
| | - Andreas Waltering
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Herbert-Lewin-Platz 3, 10623, Berlin, Germany
| | - Roland Brian Büchter
- Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670, Cologne, Germany
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Garcia-Alamino JM, Bankhead C, Heneghan C, Pidduck N, Perera R. Impact of heterogeneity and effect size on the estimation of the optimal information size: analysis of recently published meta-analyses. BMJ Open 2017; 7:e015888. [PMID: 29122784 PMCID: PMC5695413 DOI: 10.1136/bmjopen-2017-015888] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To estimate the proportion of systematic reviews that meet the optimal information size (OIS) and assess the impact heterogeneity and effect size have on the OIS estimate by type of outcome (eg, mortality, semiobjective or subjective). METHODS We carried out searches of Medline and Cochrane to retrieve meta-analyses published in systematic reviews from 2010 to 2012. We estimated the OIS using Trial Sequential Analysis software (TSA V.0.9) and based on several heterogeneity and effect size scenarios, stratifying by type of outcome (mortality/semiobjective/subjective) and by Cochrane/non-Cochrane reviews. RESULTS We included 137 meta-analyses out of 218 (63%) potential systematic reviews (one meta-analysis from each systematic review). Of these reviews, 83 (61%) were Cochrane and 54 (39%) non-Cochrane. The Cochrane reviews included a mean of 6.5 (SD 6.1) studies and the non-Cochrane included a mean of 13.2 (SD 10.2) studies. The mean number of patients was 2619.1 (SD 6245.8 or median 586.0) for the Cochrane and 19 888.5 (SD 32 925.7 or median 6566.5) patients for the non-Cochrane reviews. The percentage of systematic reviews that achieved the OIS for all-cause mortality outcome were 0% Cochrane and 25% for non-Cochrane reviews; for semiobjective outcome 17% for Cochrane and 46% for non-Cochrane reviews and for subjective outcome 45% for Cochrane and 72% for non-Cochrane reviews. CONCLUSIONS The number of systematic reviews that meet an optimal information size is low and varies depending on the type of outcome and the type of publication. Less than half of primary outcomes synthesised in systematic reviews achieve the OIS, and therefore the conclusions are subject to substantial uncertainty.
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Affiliation(s)
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Hasan H, Muhammed T, Yu J, Taguchi K, Samargandi OA, Howard AF, Lo AC, Olson R, Goddard K. "Assessing the methodological quality of systematic reviews in radiation oncology: A systematic review". Cancer Epidemiol 2017; 50:141-149. [PMID: 28915472 DOI: 10.1016/j.canep.2017.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/22/2017] [Accepted: 08/22/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the methodological quality of systematic reviews and meta-analyses in Radiation Oncology. METHODS A systematic literature search was conducted for all eligible systematic reviews and meta-analyses in Radiation Oncology from 1966 to 2015. Methodological characteristics were abstracted from all works that satisfied the inclusion criteria and quality was assessed using the critical appraisal tool, AMSTAR. Regression analyses were performed to determine factors associated with a higher score of quality. RESULTS Following exclusion based on a priori criteria, 410 studies (157 systematic reviews and 253 meta-analyses) satisfied the inclusion criteria. Meta-analyses were found to be of fair to good quality while systematic reviews were found to be of less than fair quality. Factors associated with higher scores of quality in the multivariable analysis were including primary studies consisting of randomized control trials, performing a meta-analysis, and applying a recommended guideline related to establishing a systematic review protocol and/or reporting. CONCLUSIONS Systematic reviews and meta-analyses may introduce a high risk of bias if applied to inform decision-making based on AMSTAR. We recommend that decision-makers in Radiation Oncology scrutinize the methodological quality of systematic reviews and meta-analyses prior to assessing their utility to inform evidence-based medicine and researchers adhere to methodological standards outlined in validated guidelines when embarking on a systematic review.
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Affiliation(s)
- Haroon Hasan
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada.
| | - Taaha Muhammed
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Jennifer Yu
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada
| | - Kelsi Taguchi
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada
| | - Osama A Samargandi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, PO Box 80215, Jeddah, Saudi Arabia; Division of Plastic and Reconstructive Surgery, Dalhousie University, Faculty of Medicine, Halifax, Nova Scotia, B3H 4R2, Canada
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5, Canada
| | - Andrea C Lo
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Robert Olson
- British Columbia Cancer Agency - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
| | - Karen Goddard
- Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, 600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada; Department of Surgery, Faculty of Medicine, 950 West 10th. Avenue, Vancouver, British Columbia, V5Z 1M9, Canada
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Horvath H, Brindis CD, Reyes EM, Yamey G, Franck L. Preterm birth: the role of knowledge transfer and exchange. Health Res Policy Syst 2017; 15:78. [PMID: 28874160 PMCID: PMC5586007 DOI: 10.1186/s12961-017-0238-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 08/03/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Preterm birth (PTB) is the leading cause of death in children under age five. Healthcare policy and other decision-making relevant to PTB may rely on obsolete, incomplete or inapplicable research evidence, leading to worsened outcomes. Appropriate knowledge transfer and exchange (KTE) strategies are an important component of efforts to reduce the global PTB burden. We sought to develop a 'landscape' analysis of KTE strategies currently used in PTB and related contexts, and to make recommendations for optimising programmatic implementation and for future research. METHODS In the University of California, San Francisco's Preterm Birth Initiative, we convened a multidisciplinary working group and examined KTE frameworks. After selecting a widely-used, adaptable, theoretically-strong framework we reviewed the literature to identify evidence-based KTE strategies. We analysed KTE approaches focusing on key PTB stakeholders (individuals, families and communities, healthcare providers and policymakers). Guided by the framework, we articulated KTE approaches that would likely improve PTB outcomes. We further applied the KTE framework in developing recommendations. RESULTS We selected the Linking Research to Action framework. Searches identified 19 systematic reviews, including two 'reviews of reviews'. Twelve reviews provided evidence for KTE strategies in the context of maternal, neonatal and child health, though not PTB specifically; seven reviews provided 'cross-cutting' evidence that could likely be generalised to PTB contexts. For individuals, families and communities, potentially effective KTE strategies include community-based approaches, 'decision aids', regular discussions with providers and other strategies. For providers, KTE outcomes may be improved through local opinion leaders, electronic reminders, multifaceted strategies and other approaches. Policy decisions relevant to PTB may best be informed through the use of evidence briefs, deliberative dialogues, the SUPPORT tools for evidence-informed policymaking and other strategies. Our recommendations for research addressed knowledge gaps in regard to partner engagement, applicability and context, implementation strategy research, monitoring and evaluation, and infrastructure for sustainable KTE efforts. CONCLUSIONS Evidence-based KTE, using strategies appropriate to each stakeholder group, is essential to any effort to improve health at the population level. PTB stakeholders should be fully engaged in KTE and programme planning from its earliest stages, and ideally before planning begins.
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Affiliation(s)
- Hacsi Horvath
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, 550 Sixteenth Street, third floor, San Francisco, CA 94158 United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA United States of America
- Global Health Sciences, University of California, San Francisco, San Francisco, CA United States of America
| | - Claire D. Brindis
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA United States of America
- Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA United States of America
| | - E. Michael Reyes
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA United States of America
| | - Gavin Yamey
- Global Health Sciences, University of California, San Francisco, San Francisco, CA United States of America
- Present affiliation: Duke Global Health Institute, Duke University, Durham, NC United States of America
| | - Linda Franck
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA United States of America
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Pussegoda K, Turner L, Garritty C, Mayhew A, Skidmore B, Stevens A, Boutron I, Sarkis-Onofre R, Bjerre LM, Hróbjartsson A, Altman DG, Moher D. Systematic review adherence to methodological or reporting quality. Syst Rev 2017; 6:131. [PMID: 28720117 PMCID: PMC5516390 DOI: 10.1186/s13643-017-0527-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 06/16/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Guidelines for assessing methodological and reporting quality of systematic reviews (SRs) were developed to contribute to implementing evidence-based health care and the reduction of research waste. As SRs assessing a cohort of SRs is becoming more prevalent in the literature and with the increased uptake of SR evidence for decision-making, methodological quality and standard of reporting of SRs is of interest. The objective of this study is to evaluate SR adherence to the Quality of Reporting of Meta-analyses (QUOROM) and PRISMA reporting guidelines and the A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Overview Quality Assessment Questionnaire (OQAQ) quality assessment tools as evaluated in methodological overviews. METHODS The Cochrane Library, MEDLINE®, and EMBASE® databases were searched from January 1990 to October 2014. Title and abstract screening and full-text screening were conducted independently by two reviewers. Reports assessing the quality or reporting of a cohort of SRs of interventions using PRISMA, QUOROM, OQAQ, or AMSTAR were included. All results are reported as frequencies and percentages of reports and SRs respectively. RESULTS Of the 20,765 independent records retrieved from electronic searching, 1189 reports were reviewed for eligibility at full text, of which 56 reports (5371 SRs in total) evaluating the PRISMA, QUOROM, AMSTAR, and/or OQAQ tools were included. Notable items include the following: of the SRs using PRISMA, over 85% (1532/1741) provided a rationale for the review and less than 6% (102/1741) provided protocol information. For reports using QUOROM, only 9% (40/449) of SRs provided a trial flow diagram. However, 90% (402/449) described the explicit clinical problem and review rationale in the introduction section. Of reports using AMSTAR, 30% (534/1794) used duplicate study selection and data extraction. Conversely, 80% (1439/1794) of SRs provided study characteristics of included studies. In terms of OQAQ, 37% (499/1367) of the SRs assessed risk of bias (validity) in the included studies, while 80% (1112/1387) reported the criteria for study selection. CONCLUSIONS Although reporting guidelines and quality assessment tools exist, reporting and methodological quality of SRs are inconsistent. Mechanisms to improve adherence to established reporting guidelines and methodological assessment tools are needed to improve the quality of SRs.
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Affiliation(s)
- Kusala Pussegoda
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
| | - Lucy Turner
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
| | - Chantelle Garritty
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
- Translational Research in Biomedicine (TRIBE) Program, University of Split School of Medicine, Split, Croatia
| | - Alain Mayhew
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Becky Skidmore
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
| | - Adrienne Stevens
- Ottawa Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada
- Translational Research in Biomedicine (TRIBE) Program, University of Split School of Medicine, Split, Croatia
| | - Isabelle Boutron
- Paris Descartes University, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), UMR 1153, INSERM, Paris, France
| | | | - Lise M Bjerre
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Asbjørn Hróbjartsson
- Center for Evidence-Based Medicine, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology; Canadian EQUATOR Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Centre for Practice-Changing Research, Ottawa, ON, Canada.
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Beyer W, Palache A, Boulfich M, Osterhaus A. Rationale for two influenza B lineages in seasonal vaccines: A meta-regression study on immunogenicity and controlled field trials. Vaccine 2017; 35:4167-4176. [DOI: 10.1016/j.vaccine.2017.06.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 06/12/2017] [Accepted: 06/13/2017] [Indexed: 11/29/2022]
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Pussegoda K, Turner L, Garritty C, Mayhew A, Skidmore B, Stevens A, Boutron I, Sarkis-Onofre R, Bjerre LM, Hróbjartsson A, Altman DG, Moher D. Identifying approaches for assessing methodological and reporting quality of systematic reviews: a descriptive study. Syst Rev 2017; 6:117. [PMID: 28629396 PMCID: PMC5477124 DOI: 10.1186/s13643-017-0507-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/31/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The methodological quality and completeness of reporting of the systematic reviews (SRs) is fundamental to optimal implementation of evidence-based health care and the reduction of research waste. Methods exist to appraise SRs yet little is known about how they are used in SRs or where there are potential gaps in research best-practice guidance materials. The aims of this study are to identify reports assessing the methodological quality (MQ) and/or reporting quality (RQ) of a cohort of SRs and to assess their number, general characteristics, and approaches to 'quality' assessment over time. METHODS The Cochrane Library, MEDLINE®, and EMBASE® were searched from January 1990 to October 16, 2014, for reports assessing MQ and/or RQ of SRs. Title, abstract, and full-text screening of all reports were conducted independently by two reviewers. Reports assessing the MQ and/or RQ of a cohort of ten or more SRs of interventions were included. All results are reported as frequencies and percentages of reports. RESULTS Of 20,765 unique records retrieved, 1189 of them were reviewed for full-text review, of which 76 reports were included. Eight previously published approaches to assessing MQ or reporting guidelines used as proxy to assess RQ were used in 80% (61/76) of identified reports. These included two reporting guidelines (PRISMA and QUOROM) and five quality assessment tools (AMSTAR, R-AMSTAR, OQAQ, Mulrow, Sacks) and GRADE criteria. The remaining 24% (18/76) of reports developed their own criteria. PRISMA, OQAQ, and AMSTAR were the most commonly used published tools to assess MQ or RQ. In conjunction with other approaches, published tools were used in 29% (22/76) of reports, with 36% (8/22) assessing adherence to both PRISMA and AMSTAR criteria and 26% (6/22) using QUOROM and OQAQ. CONCLUSIONS The methods used to assess quality of SRs are diverse, and none has become universally accepted. The most commonly used quality assessment tools are AMSTAR, OQAQ, and PRISMA. As new tools and guidelines are developed to improve both the MQ and RQ of SRs, authors of methodological studies are encouraged to put thoughtful consideration into the use of appropriate tools to assess quality and reporting.
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Affiliation(s)
- Kusala Pussegoda
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Lucy Turner
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Chantelle Garritty
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Translational Research in Biomedicine (TRIBE) Program, University of Split School of Medicine, Split, Croatia
| | - Alain Mayhew
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrienne Stevens
- Ottawa Methods Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Translational Research in Biomedicine (TRIBE) Program, University of Split School of Medicine, Split, Croatia
| | - Isabelle Boutron
- INSERM, UMR 1153, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Rafael Sarkis-Onofre
- Graduate Program in Dentistry, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Lise M Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Asbjørn Hróbjartsson
- Center for Evidence-Based Medicine, University of Southern Denmark & Odense University Hospital, Odense, Denmark
| | - Douglas G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Moher
- Centre for Journalology, Canadian EQUATOR Centre, Clinical Epidemiology Program, Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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Saunders-Hastings P, Reisman J, Krewski D. Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis. PLoS One 2016; 11:e0168262. [PMID: 27977760 PMCID: PMC5158032 DOI: 10.1371/journal.pone.0168262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Influenza pandemics occur when a novel influenza strain, to which humans are immunologically naïve, emerges to cause infection and illness on a global scale. Differences in the viral properties of pandemic strains, relative to seasonal ones, can alter the effectiveness of interventions typically implemented to control seasonal influenza burden. As a result, annual control activities may not be sufficient to contain an influenza pandemic. PURPOSE This study seeks to inform pandemic policy and planning initiatives by reviewing the effectiveness of previous interventions to reduce pandemic influenza transmission and infection. Results will inform the planning and design of more focused in-depth systematic reviews for specific types of interventions, thus providing the most comprehensive and current understanding of the potential for alternative interventions to mitigate the burden of pandemic influenza. METHODS A systematic review and narrative synthesis of existing systematic reviews and meta-analyses examining intervention effectiveness in containing pandemic influenza transmission was conducted using information collected from five databases (PubMed, Medline, Cochrane, Embase, and Cinahl/EBSCO). Two independent reviewers conducted study screening and quality assessment, extracting data related to intervention impact and effectiveness. RESULTS AND DISCUSSION Most included reviews were of moderate to high quality. Although the degree of statistical heterogeneity precluded meta-analysis, the present systematic review examines the wide variety of interventions that can impact influenza transmission in different ways. While it appears that pandemic influenza vaccination provides significant protection against infection, there was insufficient evidence to conclude that antiviral prophylaxis, seasonal influenza cross-protection, or a range of non-pharmaceutical strategies would provide appreciable protection when implemented in isolation. It is likely that an optimal intervention strategy will employ a combination of interventions in a layered approach, though more research is needed to substantiate this proposition. TRIAL REGISTRATION PROSPERO 42016039803.
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Affiliation(s)
- Patrick Saunders-Hastings
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Jane Reisman
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
| | - Daniel Krewski
- University of Ottawa, McLaughlin Centre for Population Health Risk Assessment, Ottawa, Ontario, Canada
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20
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Jin YH, Wang GH, Sun YR, Li Q, Zhao C, Li G, Si JH, Li Y, Lu C, Shang HC. A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews. BMJ Open 2016; 6:e011514. [PMID: 28186925 PMCID: PMC5129070 DOI: 10.1136/bmjopen-2016-011514] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing (TCMN) interventions in Chinese journals. These interventions include acupressure, massage, Tai Chi, Qi Gong, electroacupuncture and use of Chinese herbal medicines-for example, in enemas, foot massage and compressing the umbilicus. DESIGN A systematic literature search for systematic reviews and meta-analyses of TCMN interventions was performed. Review characteristics were extracted. The methodological quality and the quality of the evidence were evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches. RESULT We included 20 systematic reviews and meta-analyses, and a total of 11 TCMN interventions were assessed in the 20 reviews. The compliance with AMSTAR checklist items ranged from 4.5 to 8 and systematic reviews/meta-analyses were, on average, of medium methodological quality. The quality of the evidence we assessed ranged from very low to moderate; no high-quality evidence was found. The top two causes for downrating confidence in effect estimates among the 31 bodies of evidence assessed were the risk of bias and inconsistency. CONCLUSIONS There is room for improvement in the methodological quality of systematic reviews/meta-analyses of TCMN interventions published in Chinese journals. Greater efforts should be devoted to ensuring a more comprehensive search strategy, clearer specification of the interventions of interest in the eligibility criteria and identification of meaningful outcomes for clinicians and patients (consumers). The overall quality of evidence among reviews remains suboptimal, which raise concerns about their roles in influencing clinical practice. Thus, the conclusions in reviews we assessed must be treated with caution and their roles in influencing clinical practice should be limited. A critical appraisal of systematic reviews/meta-analyses of TCMN interventions is particularly important to provide sound guidance for TCMN.
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Affiliation(s)
- Ying-Hui Jin
- Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guo-Hao Wang
- Nursing Department, North China University of Science and Technology Affiliated Hospital, TangShan, China
| | - Yi-Rong Sun
- Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qi Li
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chen Zhao
- Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ge Li
- Public Health Department of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jin-Hua Si
- Library of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Li
- Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Cui Lu
- Emergency Department, Tianjin TEDA hospital, Tianjin, China
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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21
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Hintergrundpapier der STIKO: Evaluation der bestehenden Influenzaimpfempfehlung für Indikationsgruppen und für Senioren (Standardimpfung ab 60 Jahren). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1606-1622. [PMID: 27815578 DOI: 10.1007/s00103-016-2467-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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22
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Wu XY, Du XJ, Ho RS, Lee CC, Yip BH, Wong MC, Wong SY, Chung VC. Characteristics and Methodological Quality of Meta-Analyses on Hypertension Treatments-A Cross-Sectional Study. J Clin Hypertens (Greenwich) 2016; 19:137-142. [DOI: 10.1111/jch.12889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/19/2016] [Accepted: 06/22/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Xin Yin Wu
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
- Hong Kong Institute of Integrative Medicine; The Chinese University of Hong Kong; Hong Kong China
- the Hong Kong Branch of The Chinese Cochrane Centre; The Chinese University of Hong Kong; Hong Kong China
| | - Xin Jian Du
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Robin S.T. Ho
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Clarence C.Y. Lee
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Benjamin H.K. Yip
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Martin C.S. Wong
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Samuel Y.S. Wong
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
| | - Vincent C.H. Chung
- Jockey Club School of Public Health and Primary Care; The Chinese University of Hong Kong; Hong Kong China
- Hong Kong Institute of Integrative Medicine; The Chinese University of Hong Kong; Hong Kong China
- the Hong Kong Branch of The Chinese Cochrane Centre; The Chinese University of Hong Kong; Hong Kong China
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23
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Burda BU, Holmer HK, Norris SL. Limitations of A Measurement Tool to Assess Systematic Reviews (AMSTAR) and suggestions for improvement. Syst Rev 2016; 5:58. [PMID: 27072548 PMCID: PMC4830078 DOI: 10.1186/s13643-016-0237-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/05/2016] [Indexed: 01/04/2023] Open
Abstract
A Measurement Tool to Assess Systematic Reviews (AMSTAR) is a commonly used tool to assess the quality of systematic reviews; however, modifications are needed to improve its usability, reliability, and validity. In this commentary, we summarize our experience and the experiences of others who have used AMSTAR and provide suggestions for its improvement. We propose that AMSTAR should modify a number of individual items and their instructions and responses to make them more congruent with an assessment of the methodologic quality of systematic reviews. We recommend adding new items and modifying existing items to assess the quality of the body of evidence and to address subgroup and sensitivity analyses. More detailed instructions are needed for scoring individual items across multiple reviewers, and we recommend that a total score should not be calculated. These suggestions need to be empirically tested prior to implementation.
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Affiliation(s)
- Brittany U Burda
- Kaiser Permanente Center for Health Research, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Haley K Holmer
- Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Susan L Norris
- World Health Organization, Av. Appia 20, CH-1211, Geneva, 27, Switzerland
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24
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DiSilvestro KJ, Tjoumakaris FP, Maltenfort MG, Spindler KP, Freedman KB. Systematic Reviews in Sports Medicine. Am J Sports Med 2016; 44:533-8. [PMID: 25899433 DOI: 10.1177/0363546515580290] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The number of systematic reviews published in the orthopaedic literature has increased, and these reviews can help guide clinical decision making. However, the quality of these reviews can affect the reader's ability to use the data to arrive at accurate conclusions and make clinical decisions. PURPOSE To evaluate the methodological and reporting quality of systematic reviews and meta-analyses in the sports medicine literature to determine whether such reviews should be used to guide treatment decisions. The hypothesis was that many systematic reviews in the orthopaedic sports medicine literature may not follow the appropriate reporting guidelines or methodological criteria recommended for systematic reviews. STUDY DESIGN Systematic review. METHODS All clinical sports medicine systematic reviews and meta-analyses from 2009 to 2013 published in The American Journal of Sports Medicine (AJSM), The Journal of Bone and Joint Surgery (JBJS), Arthroscopy, Sports Health, and Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) were reviewed and evaluated for level of evidence according to the guidelines from the Oxford Centre for Evidence-Based Medicine, for reporting quality according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, and for methodological quality according to the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Analysis was performed by year and journal of publication, and the levels of evidence included in the systematic reviews were also analyzed. RESULTS A total of 200 systematic reviews and meta-analyses were identified over the study period. Of these, 53% included evidence levels 4 and 5 in their analyses, with just 32% including evidence levels 1 and 2 only. There were significant differences in the proportion of articles with high levels of evidence (P < .001) and low levels of evidence (P = .005) by journal. The average PRISMA score was 87% and the average AMSTAR score was 73% among all journals. The average AMSTAR and PRISMA scores were significantly different by journal (P = .002 and .001, respectively) and by year (P = .046 and .019, respectively). Arthroscopy, AJSM, and JBJS all scored higher than Sports Health and KSSTA on the PRISMA and AMSTAR. The average PRISMA score by year varied from 85% to 89%, and the average AMSTAR score varied from 70% to 76%. CONCLUSION Systematic reviews and meta-analyses in orthopaedics sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. Overall, PRISMA and AMSTAR scores are high and may be better than those in other disciplines. Readers need to be conscious of potential shortcomings when reading systematic reviews and using them in practice.
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Affiliation(s)
| | - Fotios P Tjoumakaris
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mitchell G Maltenfort
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kurt P Spindler
- Cleveland Clinic, Department of Orthopaedic Surgery, Cleveland, Ohio, USA
| | - Kevin B Freedman
- Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Wasiak J, Shen AY, Tan HB, Mahar R, Kan G, Khoo WR, Faggion CM. Methodological quality assessment of paper-based systematic reviews published in oral health. Clin Oral Investig 2015; 20:399-431. [PMID: 26589200 DOI: 10.1007/s00784-015-1663-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/11/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to conduct a methodological assessment of paper-based systematic reviews (SR) published in oral health using a validated checklist. A secondary objective was to explore temporal trends on methodological quality. MATERIAL AND METHODS Two electronic databases (OVID Medline and OVID EMBASE) were searched for paper-based SR of interventions published in oral health from inception to October 2014. Manual searches of the reference lists of paper-based SR were also conducted. Methodological quality of included paper-based SR was assessed using an 11-item questionnaire, Assessment of Multiple Systematic Reviews (AMSTAR) checklist. Methodological quality was summarized using the median and inter-quartile range (IQR) of the AMSTAR score over different categories and time periods. RESULTS A total of 643 paper-based SR were included. The overall median AMSTAR score was 4 (IQR 2-6). The highest median score (5) was found in the pain dentistry and periodontology fields, while the lowest median score (3) was found in implant dentistry, restorative dentistry, oral medicine, and prosthodontics. The number of paper-based SR per year and the median AMSTAR score increased over time (median score in 1990s was 2 (IQR 2-3), 2000s was 4 (IQR 2-5), and 2010 onwards was 5 (IQR 3-6)). CONCLUSION Although the methodological quality of paper-based SR published in oral health has improved in the last few years, there is still scope for improving quality in most evaluated dental specialties. CLINICAL RELEVANCE Large-scale assessment of methodological quality of dental SR highlights areas of methodological strengths and weaknesses that can be targeted in future publications to encourage better quality review methodology.
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Affiliation(s)
- J Wasiak
- Epworth Healthcare, Richmond, VIC, Australia.,School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, Melbourne Dental School, Melbourne, Australia
| | - A Y Shen
- Eastern Health, C/O - Box Hill Hospital, Box Hill, Melbourne, Australia.
| | - H B Tan
- Alfred Health, Melbourne, Australia
| | - R Mahar
- School of Population Health, University of Queensland, Brisbane, Australia
| | - G Kan
- Melbourne Health, Melbourne, Australia
| | - W R Khoo
- Southern Health, Melbourne, Australia
| | - C M Faggion
- Department of Periodontology, Faculty of Dentistry, University of Münster, Münster, Germany
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Discrepancies in Outcome Reporting Exist Between Protocols and Published Oral Health Cochrane Systematic Reviews. PLoS One 2015; 10:e0137667. [PMID: 26368938 PMCID: PMC4569349 DOI: 10.1371/journal.pone.0137667] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/20/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives To assess discrepancies in the analyzed outcomes between protocols and published reviews within Cochrane oral health systematic reviews (COHG) on the Cochrane Database of Systematic Reviews (CDSR). Study Design and Setting All COHG systematic reviews on the CDSR and the corresponding protocols were retrieved in November 2014 and information on the reported outcomes was recorded. Data was collected at the systematic review level by two reviewers independently. Results One hundred and fifty two reviews were included. In relation to primary outcomes, 11.2% were downgraded to secondary outcomes, 9.9% were omitted altogether in the final publication and new primary outcomes were identified in 18.4% of publications. For secondary outcomes, 2% were upgraded to primary, 12.5% were omitted and 30.9% were newly introduced in the publication. Overall, 45.4% of reviews had at least one discrepancy when compared to the protocol; these were reported in 14.5% reviews. The number of review updates appears to be associated with discrepancies between final review and protocol (OR: 3.18, 95% CI: 1.77, 5.74, p<0.001). The risk of reporting significant results was lower for both downgraded outcomes [RR: 0.52, 95% CI: 0.17, 1.58, p = 0.24] and upgraded or newly introduced outcomes [RR: 0.77, 95% CI: 0.36, 1.64, p = 0.50] compared to outcomes with no discrepancies. The risk of reporting significant results was higher for upgraded or newly introduced outcomes compared to downgraded outcomes (RR = 1.19, 95% CI: 0.65, 2.16, p = 0.57). None of the comparisons reached statistical significance. Conclusion While no evidence of selective outcome reporting was found in this study, based on the present analysis of SRs published within COHG systematic reviews, discrepancies between outcomes in pre-published protocols and final reviews continue to be common. Solutions such as the use of standardized outcomes to reduce the prevalence of this issue may need to be explored.
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Halila GC, Czepula AIDS, Otuki MF, Correr CJ. Review of the efficacy and safety of over-the-counter medicine. BRAZ J PHARM SCI 2015. [DOI: 10.1590/s1984-82502015000200018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
<p>Over-the-counter medicines are available without prescription because of their safety and effectiveness, to treat minor ailments and symptoms. The objective of the study was to analyze the availability and quality of systematic reviews published about nonprescription medicines, identifying the groups for which there are gaps in evidence. We identified published articles through the Cochrane Database of Systematic Review and MEDLINE, from the start of the database until May 2012, using the search terms "nonprescription drugs," "over the counter," and "OTC." We searched for articles that describe systematic reviews addressing the efficacy and safety of drugs dispensed without a prescription, according to the lists published by the Association of the European Self-Medication Industry and in Brazil, in the clinical conditions listed in Groups and Specified Therapeutic Indications. We included 49 articles, 18 articles were of moderate quality and 31 of high quality. Of the studies, 74.5% demonstrated efficacy in favor of the use of drugs evaluated. Of the 24 studies that evaluated safety, 21% showed evidence unfavorable to the drug. Overall, the evidence found in the studies included in the overview is favorable to the use of the drugs evaluated. However, there are gaps in evidence for some therapy groups.</p>
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Affiliation(s)
- Gerusa Clazer Halila
- Universidade Federal do Paraná, Brazil; Universidade Estadual de Ponta Grossa, Brazil
| | | | - Michel Fleith Otuki
- Universidade Federal do Paraná, Brazil; Universidade Estadual de Ponta Grossa, Brazil
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Faggion CM, Listl S, Alarcón MA. Is the evaluation of risk of bias in periodontology and implant dentistry comprehensive? A systematic review. J Clin Periodontol 2015; 42:488-94. [DOI: 10.1111/jcpe.12394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/08/2023]
Affiliation(s)
- Clovis Mariano Faggion
- Department of Periodontology; Faculty of Dentistry; University of Münster; Münster Germany
| | - Stefan Listl
- Department of Conservative Dentistry; Heidelberg University; Heidelberg Germany
- Munich Center for the Economics of Aging; Max Planck Institute for Social Law and Social Policy; Munich Germany
| | - Marco Antonio Alarcón
- Department of Periodontology and Implant Dentistry; Cayetano Heredia Peruvian University; Lima Peru
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Remschmidt C, Wichmann O, Harder T. Influenza vaccination in patients with end-stage renal disease: systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness, and safety. BMC Med 2014; 12:244. [PMID: 25523432 PMCID: PMC4298993 DOI: 10.1186/s12916-014-0244-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/24/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Vaccination against influenza is recommended in patients with end-stage renal disease (ESRD). However, so far, no systematic review has summarized the available evidence on the effectiveness and safety of influenza vaccination in this patient group. METHODS We conducted a systematic review and meta-analysis and assessed the quality of evidence using the GRADE methodology. We searched MEDLINE, EMBASE, Cochrane Library databases, ClinicalTrials.gov, and reference lists for studies on efficacy, effectiveness, and/or safety of seasonal influenza vaccination in patients with ESRD receiving dialysis. All reported clinical outcomes were considered, including all-cause mortality, cardiac death, infectious death, all-cause hospitalization, hospitalization due to influenza or pneumonia, hospitalization due to bacteremia, viremia, or septicemia, hospitalization due to respiratory infection, ICU admission, and influenza-like illness. RESULTS Five observational studies and no randomized-controlled trial were identified. In four studies, risk of bias was high regarding all reported outcomes. Strong residual confounding was likely to be present in one study reporting on three outcomes, as indicated by significant protective effects of vaccination outside influenza seasons. Therefore, the statistically significant protective effects on all-cause mortality (vaccine effectiveness (VE), 32%; 95% CI, 24-39%), cardiac death (VE, 16%; 95% CI, 1-29%), hospitalization due to influenza or pneumonia (VE, 14%; 95% CI, 7-20%), ICU admission (VE, 81%; 95% CI, 63-86%), and influenza-like illness (VE, 12%; 95% CI, 10-14%) have to be taken with caution. According to GRADE, the quality of the body of evidence was considered very low for all outcomes. No study reported on laboratory-confirmed influenza virus infections or on safety endpoints. CONCLUSIONS Evidence on the protective effects of influenza vaccination in patients with ESRD is limited and of very low quality. Since VE estimates in the available literature are prone to unmeasured confounding, studies using randomization or quasi-experimental designs are needed to determine the extent by which vaccination prevents influenza and related clinical outcomes in this at-risk population. However, given the high rates of health-endangering events in these patients, even a low VE can be considered as sufficient to recommend annual influenza vaccination.
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Affiliation(s)
- Cornelius Remschmidt
- Robert Koch Institute, Immunization Unit, Seestrasse 10, 13353, Berlin, Germany.
| | - Ole Wichmann
- Robert Koch Institute, Immunization Unit, Seestrasse 10, 13353, Berlin, Germany.
| | - Thomas Harder
- Robert Koch Institute, Immunization Unit, Seestrasse 10, 13353, Berlin, Germany.
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Østerhus SF. Influenza vaccination: a summary of Cochrane Reviews. Eur J Clin Microbiol Infect Dis 2014; 34:205-13. [PMID: 25185860 DOI: 10.1007/s10096-014-2236-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 08/19/2014] [Indexed: 01/08/2023]
Abstract
The Cochrane Library was systematically searched for meta-analyses regarding influenza vaccination of various populations, both healthy and sick. An effect in reducing the number of cases of influenza, influenza-like illness or complications to influenza was found in some studies, but, generally, the quality of the studies was low, and several studies lacked hard clinical endpoints. Data on adverse effects were scarce. More randomised controlled trials investigating the effects of influenza vaccination are warranted.
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Affiliation(s)
- S F Østerhus
- General Practice Research Unit, University of Copenhagen, Suhrsgade 4A, 4930, Maribo, Denmark,
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Remschmidt C, Wichmann O, Harder T. Influenza vaccination in HIV-infected individuals: Systematic review and assessment of quality of evidence related to vaccine efficacy, effectiveness and safety. Vaccine 2014; 32:5585-92. [DOI: 10.1016/j.vaccine.2014.07.101] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/17/2014] [Accepted: 07/31/2014] [Indexed: 01/08/2023]
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