The quality of reports of randomized clinical trials on traditional Chinese medicine treatments: a systematic review of articles indexed in the China National Knowledge Infrastructure database from 2005 to 2012

Network pharmacology-based screening of active constituents of Avicennia marina and their clinical biochemistry related mechanism against breast cancer

Breast cancer is the second major cause of cancer death in women globally. Avicennia marina is a medicinal plant that belongs to the family Acanthaceae and is known as grey or white mangrove. It has antioxidant, antiviral, anticancer, anti-inflammatory, and antibacterial activity in the treatment of various diseases including cancer. The goal of the study is to use a network pharmacology method to identify the potential phenomena of bioactive compounds of A. marina in the treatment of breast cancer and explore clinical biochemistry related aspects. A total of 74 active compounds of A. marina were retrieved from various databases as well as a literature review and collectively 429 targets of these compounds were identified by STITCH and Swiss Target Prediction databases. Breast cancer related 15606 potential targets were retrieved from the GeneCards database. A Venn diagram was drawn to find common key targets. To check the biological functions, the GO enrichment and KEGG pathways analysis of 171 key targets were performed through the DAVID database. To understand the interactions among key targets, Protein-protein interaction (PPI) studies were completed using the STRING database, and the Protein-Protein Interaction (PPI) network, as well as the compound-target-pathway network, was constructed using Cytoscape 3.9.0. Finally, molecular docking analysis of 5 hub genes named tumor protein 53 (TP53), catenin beta 1 (CTNNB1), interleukin 6 (IL6), tumor necrosis factor (TNF), and RAC-alpha serine/threonine protein kinases 1 (AKT1) with the active constituent of A. marina against breast cancer were performed. Additionally, a molecular docking study demonstrates that active drugs have a higher affinity for the target that may be used to decrease breast cancer. The molecular dynamic simulation analysis predicted the very stable behavior of docked complexes with no global structure deviations seen. The MMGBSA further supported strong intermolecular interactions with net energy values as; AKT1_Betulinic_acid (-20.97 kcal/mol), AKT1_Stigmasterol (-44.56 kcal/mol), TNF_Betulinic_acid (-28.68 kcal/mol) and TNF_Stigmastero (-29.47 kcal/mol).Communicated by Ramaswamy H. Sarma.

Pain-focused psychological interventions in women with endometriosis: A systematic review

AIMS

As a chronic inflammatory disease, endometriosis (EMS) is often associated with pain affecting different aspects of women's lives. Up to now, a wide variety of interventions have been implemented to alleviate pain in patients with this condition, including pharmacological, surgical, and rarely non-pharmacological ones. Against this background, this review aimed to investigate pain-focused psychological interventions among EMS women.

METHODS

A systematic review of the articles published in this field was conducted through a comprehensive search on the databases of Scopus, PubMed, MEDLINE, Web of Science, ScienceDirect, the Cochrane Library, PsycINFO, Google Scholar, and Scientific Information Database (SID). The quality of studies was then assessed by the Jadad Scale.

RESULTS

In total, 10 articles were entered into this systematic review. The findings further revealed that the pain-focused psychological interventions in patients with EMS were cognitive-behavioral therapy (CBT) (n = 2), mindfulness therapy (n = 4), yoga (n = 2), psychoeducation (n = 1), and progressive muscle relaxation (PMR) training (n = 1). Besides, the findings established that all the given interventions had improved and reduced pain in women living with this condition. Moreover, five articles were of good quality based on the Jadad Scale.

CONCLUSION

The study results demonstrated that all the listed psychological interventions had affected pain relief and improvement in women suffering from EMS. Considering the limited number of studies in this field and the fact that there were only five articles endowed with good quality, more high-quality studies could provide stronger evidence to support the implementation of the mentioned interventions influencing pain in patients.

Placentophagia and the Tao of POEF

Placentophagia, ingestion of placenta and amniotic fluid, usually during parturition, is a behavioral feature of nearly all nonaquatic, placental mammals, and is a nexus for several interlocking behavioral phenomena. Placentophagia has not been typical of human cultures, but in recent years, some women in affluent societies have engaged in it, thereby bringing publicity to the behavior. First, we summarized benefits of placentophagia for nonhuman mammals, which include increased attractiveness of neonates, enhanced onset of maternal behavior, suppression of pseudopregnancy, and enhancement of opioid hypoalgesia by Placental Opioid-Enhancing Factor (POEF), a benefit that may extend well outside the context of parturition. The research on POEF in animals was discussed in detail. Then we discussed placentophagia (placentophagy) in humans, and whether there is validity to the claims of various benefits reported primarily in the pro-placentophagy literature, and, although human afterbirth shows POEF activity, the POEF effect has not yet been tested in humans. Finally, we discussed the general possible implications, for the management of pain and addiction, of isolating and characterizing POEF.

Examining patterns of traditional Chinese medicine use in pediatric oncology: A systematic review, meta-analysis and data-mining study

BACKGROUND

Traditional Chinese medicine (TCM) is becoming a popular complementary approach in pediatric oncology. However, few or no meta-analyses have focused on clinical studies of the use of TCM in pediatric oncology.

OBJECTIVE

We explored the patterns of TCM use and its efficacy in children with cancer, using a systematic review, meta-analysis and data mining study.

SEARCH STRATEGY

We conducted a search of five English (Allied and Complementary Medicine Database, Embase, PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and four Chinese databases (Wanfang Data, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, and VIP Chinese Science and Technology Periodicals Database) for clinical studies published before October 2021, using keywords related to "pediatric," "cancer," and "TCM."

INCLUSION CRITERIA

We included studies which were randomized controlled trials (RCTs) or observational clinical studies, focused on patients aged < 19 years old who had been diagnosed with cancer, and included at least one group of subjects receiving TCM treatment.

DATA EXTRACTION AND ANALYSIS

The methodological quality of RCTs and observational studies was assessed using the six-item Jadad scale and the Effective Public Healthcare Panacea Project Quality Assessment Tool, respectively. Meta-analysis was used to evaluate the efficacy of combining TCM with chemotherapy. Study outcomes included the treatment response rate and occurrence of cancer-related symptoms. Association rule mining (ARM) was used to investigate the associations among medicinal herbs and patient symptoms.

RESULTS

The 54 studies included in this analysis were comprised of RCTs (63.0%) and observational studies (37.0%). Most RCTs focused on hematological malignancies (41.2%). The study outcomes included chemotherapy-induced toxicities (76.5%), infection rate (35.3%), and response, survival or relapse rate (23.5%). The methodological quality of most of the RCTs (82.4%) and observational studies (80.0%) was rated as "moderate." In studies of leukemia patients, adding TCM to conventional treatment significantly improved the clinical response rate (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.49-4.36), lowered infection rate (OR = 0.23; 95% CI = 0.13-0.40), and reduced nausea and vomiting (OR = 0.13; 95% CI = 0.08-0.23). ARM showed that Radix Astragali, the most commonly used medicinal herb (58.0%), was associated with treating myelosuppression, gastrointestinal complications, and infection.

CONCLUSION

There is growing evidence that TCM is an effective adjuvant therapy for children with cancer. We proposed a checklist to improve the quality of TCM trials in pediatric oncology. Future work will examine the use of ARM techniques on real-world data to evaluate the efficacy of medicinal herbs and drug-herb interactions in children receiving TCM as a part of integrated cancer therapy.

Psychological Interventions in Chemotherapy-Induced Nausea and Vomiting in Women with Breast Cancer: A Systematic Review

Background

Nausea and vomiting are considered the most common side effects of chemotherapy, and they can affect different dimensions of the lives of women with breast cancer. Thus, the management of these complications is of great significance. Various interventions are drawn upon to alleviate nausea and vomiting. This review aimed to investigate the effects of psychological interventions on chemotherapy-induced nausea and vomiting among women with breast cancer.

Methods

A systematic review of clinical or quasi-experimental clinical trials published from 2000 to 2020 on the effects of psychological interventions on nausea and vomiting induced by chemotherapy in women with breast cancer was conducted via a comprehensive search in web search engines including Google Scholar and PubMed and databases such as Web of Science, Scopus, ScienceDirect, Cochrane Library, Springer, Elsevier, Magiran, and Scientific Information Database (SID). Medical Subject Heading (MeSH) was employed with the following keywords: nausea, vomiting, breast cancer, chemotherapy, and psychological intervention. The quality of the included studies was assessed via the Jadad scale.

Results

Nine studies were included in this systematic review. Psychological interventions in chemotherapy-induced nausea and vomiting in women with breast cancer consisted of cognitive-behavioral therapy, progressive muscle relaxation training, yoga, and guided imagery. The results indicated that in all the studies, except one, the interventions improved conditions and reduced chemotherapy-induced nausea and vomiting.

Conclusion

The results of this study indicated that psychological interventions such as cognitive-behavioral therapy, progressive muscle relaxation training, guided imagery, and yoga alleviated nausea and vomiting induced by chemotherapy in women with breast cancer. Therefore, it is recommended that these interventions be applied by healthcare providers to ameliorate nausea and vomiting in these patients.The abstract was presented in the 15th International Congress on Obstetrics and Gynecology, Tehran, Iran, 8-11 October 2019, as a poster and published in the congress book.

The Therapeutic Principle of Combined Strengthening Qi and Eliminating Pathogens in Treating Middle-Advanced Primary Liver Cancer: A Systematic Review and Meta-Analysis

Background: The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. However, there is a lack of reasonable evidence to support the proper application of this therapeutic principle. This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens.

Method: Clinical trials were obtained through searching of EMBASE, Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and two clinical trial registries. The randomized controlled trials with the combination of CMFs and transcatheter arterial chemoembolization (TACE) in the experiment group were acceptable, in contrast to the TACE alone in the control group. The statistics analysis was performed on Review Manager 5.4.

Results: A total of eligible 24 trials were accessed in this work. Overall, CMFs could improve the survival duration of 6 months, 1 year, and 2 years, Karnofsky Performance Status, tumor objective response rate (ORR), AFP, and symptom. In the subgroup analysis, trials complying with the principle of single strengthening Qi did not show any significant difference in increasing tumor ORR. Meanwhile, the principle of combined strengthening Qi and eliminating pathogens was uncertain in improving symptoms and 1-year and 2-year survival time. In addition, the outcome indexes of ALT and AST were heterogeneous. In last, the total occurrence of adverse events could not be reduced via using CMFs. Patients treated with CMFs exhibited liver injury, fever, and white blood cell decline, with mild events occurring more frequently and severe events occurring less.

Conclusion: CMFs are an effective treatment method to cure PLC at the middle-advanced stage. Adopting the principle of single strengthening Qi presents better efficacy in the long term by prolonging the survival duration. Following the principle of combined strengthening Qi and eliminating pathogens could be more beneficial to patients in short term by lessening the tumor size. CMFs have the advantage of reducing certain serious adverse events.

The Effect of Psychological Interventions on the Quality of Life in Women with Fibromyalgia: A Systematic Review

Fibromyalgia refers to a painful type of rheumatological clinical syndrome, and its prevalence varies from 0.7% to 6.6%. This syndrome is associated with different physical and psychological symptoms, which ultimately leads to a decline in women's quality of life. A wide range of pharmacological and non-pharmacological interventions are conducted to mitigate these symptoms and improve the quality of life. Therefore, the present study aims to investigate the effect of psychological interventions on the quality of life in women with fibromyalgia. This systematic review with comprehensive search was carried out on Google Scholar, Scopus, PubMed, Web of Science, Science Direct, Cochrane Library, PsycINFO, and Scientific Information Database (SID), databases using the suitable keywords, and a total of 3125 articles from 2000 to 2019 were retrieved. Finally, the quality of 16 experimental and semi-experimental clinical trials was evaluated using the Jadad scale. The psychological interventions affecting the quality of life in women with fibromialgia included cognitive-behavioral therapy and behavioral therapy, coping strategies training, mindfulness, acceptance and commitment treatment, hypnosis, meditation, music therapy, short-term psychodynamic psychotherapy and writing emotions. The results of the study showed that except four studies, the studies generally improved the quality of life and reduced the symptoms in women with fibromyalgia. The results of the study suggest that most psychological interventions affect the quality of life in women with fibromyalgia. Therefore, besides pharmacological therapy, psychological interventions can be used by health-care providers to reduce the symptoms of fibromyalgia and improve the quality of their life.

The use of complementary and integrative therapies as adjunct interventions during radiotherapy: a systematic review

PURPOSE

Literature supporting the efficacy of complementary and integrative medicine (CIM) alongside radiotherapy is fragmented with varying outcomes and levels of evidence. This review summarizes the available evidence on CIM used with radiotherapy in order to inform clinicians.

METHODS

A systematic literature review identified studies on the use of CIM during radiotherapy. Inclusion required the following criteria: the study was interventional, CIM therapy was for human patients with cancer, and CIM therapy was administered concurrently with radiotherapy. Data points of interest were collected from included studies. A subset was identified as high-quality using the Jadad scale. Fisher's exact test was used to assess the association between study results, outcome measured, and type of CIM.

RESULTS

Overall, 163 articles met inclusion. Of these, 68 (41.7%) were considered high-quality trials. Articles published per year increased over time (p < 0.01). Frequently identified therapies were biologically based therapies (47.9%), mind-body therapies (23.3%), and alternative medical systems (13.5%). Within the subset of high-quality trials, 60.0% of studies reported a favorable change with CIM while 40.0% reported no change. No studies reported an unfavorable change. Commonly assessed outcome types were patient-reported (41.1%) and provider-reported (21.5%). Rate of favorable change did not differ based on type of CIM (p = 0.90) or outcome measured (p = 0.24).

CONCLUSIONS

Concurrent CIM may reduce radiotherapy-induced toxicities and improve quality of life, suggesting that physicians should discuss CIM with patients receiving radiotherapy. This review provides a broad overview of investigations on CIM use during radiotherapy and can inform how radiation oncologists advise their patients about CIM.

Managing Rather Than Avoiding “Difficulties” in Building Landscape Resilience

Building landscape resilience inspires the cultivation of the landscape’s capacity to recover from disruption and live with changes and uncertainties. However, integrating ecosystem and society within such a unified lens—that is, socio–ecological system (SES) resilience—clashes with many cornerstone concepts in social science, such as power, democracy, rights, and culture. In short, a landscape cannot provide the same values to everyone. However, can building landscape resilience be an effective and just environmental management strategy? Research on this question is limited. A scoping literature review was conducted first to synthesise and map landscape management change based on 111,653 records. Then, we used the Nuozhadu (NZD) catchment as a case study to validate our findings from the literature. We summarised current critiques and created a framework including seven normative categories, or common difficulties, namely resilience for “whom”, “what”, “when”, “where”, “why”, as well as “can” and “how” we apply resilience normatively. We found that these difficulties are overlooked and avoided despite their instructive roles to achieve just landscape management more transparently. Without clear targets and boundaries in building resilience, we found that some groups consume resources and services at the expense of others. The NZD case demonstrates that a strategy of building the NZD’s resilience has improved the conservation of the NZD’s forest ecosystems but overlooked trade-offs between sustaining people and the environment, and between sustainable development for people at different scales. Future researchers, managers, and decision-makers are thereby needed to think resilience more normatively and address the questions in the “seven difficulties” framework before intervening to build landscape resilience.

Reporting Quality of Randomized Controlled Trials for the Treatment of Eczema with Chinese Patent Medicine Based on the CONSORT-CHM Formulas 2017

OBJECTIVE

Chinese patent medicine (CPM) has been widely used to treat eczema in mainland China for decades. This study aims to investigate circulating CPM for eczema in mainland China and to evaluate the reporting quality of randomized controlled trials (RCTs) of them by using the CONSORT-CHM formulas 2017 (Consolidated Standards of Reporting Trials for Chinese herbal medicine formulas 2017).

METHODS

Circulating CPM with the indication for eczema was selected by searching three drug databases and confirmed by contacting the manufacturers. RCTs for the treatment of eczema with CPM were selected in four Chinese literature databases and four English literature databases from their inception to August 31, 2019. The reporting quality of included RCTs was assessed based on the CONSORT-CHM formulas 2017. A univariate analysis was conducted to identify the factors associated with the reporting quality.

RESULTS

A total of 70 circulating CPMs had the indication for eczema. Among them, 21 CPMs with 144 RCTs reached the eligible criteria. The mean overall quality score (OQS) of 144 RCTs was 19.85 ± 2.73, which was much less than the maximum score of 38. Of the 38 items, 12 items were reported in over 70% of the trials, 6 items were reported in 50%-70% of the trials, and 16 items were reported in less than 50% of the trials. Publication after 2015 (P < 0.001) and the first author from a university hospital (P=0.010) were associated with the better reporting quality.

CONCLUSION

There are a lot of circulating CPMs with the indication for eczema in mainland China, but both the quantity and the reporting quality of RCTs regarding those CPMs are suboptimal. It is necessary that authors and journal editors learn and adhere to the CONSORT-CHM formulas 2017 to enhance the reporting quality of RCTs for the treatment of eczema with CPM.

Shuxuetong for Prevention of recurrence in Acute Cerebrovascular events with Embolism (SPACE) trial: rationale and design

Backgrounds

Embolic stroke is one of the main mechanisms of ischaemic stroke. Even if treated with recommended antithrombotic agents, stroke recurrence remains high. The Shuxuetong injection, a purified extract of traditional Chinese medicine widely used for thrombus diseases in clinical practice in China, could be a promising agent to prevent stroke recurrence.

Aims

To describe the design of the Shuxuetong injection for prevention of recurrence in acute ischaemic stroke with embolism mechanisms.

Design

The Shuxuetong for Prevention of recurrence in Acute Cerebrovascular events with Embolism (SPACE) trial is a multicentre, randomised, double-blind, placebo-controlled, parallel-group, superiority trial to evaluate the efficacy and safety of Shuxuetong injection in reducing recurrence or silent new ischaemic lesions on patients with acute embolic stroke within 10 days. An estimated 2416 patients with embolic stroke within 72 hours of symptom onset from 80 hospitals will be randomly assigned to one of two groups receiving Shuxuetong injection or placebo injection for 10 days. The primary endpoint is symptomatic or asymptomatic new cerebral infarction within 10 days after randomisation.

Conclusion

The SPACE Trial will provide valuable evidence for the efficacy and safety of Shuxuetong injection for the prevention of stroke recurrence in patients with imaging-defined embolic stroke.

Clinical trial registration

NCT03090113.

Systematic evaluation of therapeutic effects of stem cell transplantation trials for heart diseases in China

BACKGROUND

To systematically assess the quality of reports of clinical trials of stem cell for heart diseases published in Chinese.

METHODS

The quality of reports was assessed according to the CONSORT statement and the Jadad score. The association between the CONSORT scores and the reported therapeutic effects was evaluated.

RESULTS

A total of 36 randomized clinical trials were identified, and 1552 patients were included. The mean CONSORT score was 7.06 (SD = 2.99). The proportion of reports with a Jadad score of 3 was 8.33%. The improvement of left ventricular function, myocardial perfusion area, left ventricular diastolic diameter, and cardiac output decreased with the increase in the CONSORT score.

CONCLUSIONS

The percentages of high-quality reports published in Chinese on stem cell therapy for heart diseases are low. Although stem cell transplantation seems promising for heart diseases, high-quality studies are needed to verify the conclusions．.

Building a green Belt and Road: A systematic review and comparative assessment of the Chinese and English-language literature

International attention on the environmental impacts of China’s Belt and Road Initiative (BRI) is increasing, but little is known internationally about the large corpus of Chinese BRI environmental research. We present the first systematic review of the Chinese and English-language BRI environmental research, supported with text mining and sentiment analysis. We found that the research is dominated by Chinese authors writing about BRI routes within China in Chinese, even though concerns around BRI are largely about impacts and benefits within host countries, and the volume of publications in English is recently catching up. Different disciplines and methods are well-represented across languages, apart from specific types of Chinese social science papers. The sentiments of academic research are largely neutral and less polarised than media discourse. We recommend that scientists and practitioners should pay more attention to BRI environmental impacts in developing countries and proactively engage local voices.

Coping Strategies-Oriented Interventions in Breast Cancer Women: A Systematic Scoping Review of the Quantitative Evidence

Context: Coping strategies can predict breast cancer patients’ emotional well-being. Objectives: The aim of this systematic scoping review was to investigate the effect of coping strategies-oriented interventions on coping skills in breast cancer women. Data Sources: A systematic scoping review was conducted using a broad search across PubMed, Scopus, Springer, Elsevier, Cochrane Library, Science Direct, Web of Science, Magiran, Scientific Information Database, and Google scholar from 2009 - 2018. Study Selection: Clinical or quasi-experimental trials using interventions and control groups on the coping strategies-oriented interventions in breast cancer women in English or Persian were included. Data Extraction: Two independent researchers selected the final papers. In the case of a disagreement, the third researcher made the final decision. The quality of the included studies was assessed using the Jadad scale. Results: The coping strategies-oriented interventions were classified into four main categories: psychological interventions, such as cognitive-behavioral therapy, mindfulness, coping therapy, self-management, and psychoeducation; spiritual-religious interventions; social interventions, such as family therapy; and complementary interventions, such as acupuncture. Most interventions improved the coping skills of the studied women. Based on the Jadad scale, only two studies had good quality. Conclusions: Considering that most interventions improved the coping skills of breast cancer women, it is suggested that healthcare providers be proficient in examination techniques that maximize the patient’s coping skills. However, there remains a need for further culture-based research to adopt the best interventions and make changes in policy.

Analysis of reporting completeness in exercise cancer trials: a systematic review

Background

Exercise is an effective therapeutic intervention for cancer survivors. Concerns about the completeness of reporting of exercise interventions have been raised in the literature, but without any formal analysis. This study aimed to evaluate the completeness of reporting of exercise interventions for cancer survivors in a large sample of randomized clinical trials (RCTs).

Methods

We developed a pre-defined protocol. We searched MEDLINE, EMBASE, and CENTRAL for exercise trials in oncology between 2010 and 2017. Pairs of independent researchers screened the records, extracted study characteristics, and assessed 16 items on the TIDieR checklist (i.e., the 12 items, with item 5 divided into two and item 8 divided into four). For each of these items, the percentage of interventions in the included studies that reported the item was calculated.

Results

We included 131 RCTs reporting 138 interventions in the analysis. Breast cancer was the most common type of cancer (69, 50%), and aerobic exercise was the most studied exercise modality (43, 30%) followed by combined aerobic and resistance training (40, 28%). Completeness of reporting ranged from 42 to 96% among the TIDieR items; none of the items was fully reported. ‘Intervention length’ was the most reported item across interventions (133, 96%), followed by ‘rationale’ (131, 95%), whereas ‘provider’ (58, 42%) and ‘how well (planned)’ (63, 46%) were the two least reported items. Half of the TIDieR items were completely reported in 50 to 70% of the interventions, and only four items were reported in more than 80% of the interventions (Items 2 and 8a to c). The seven items deemed to be core for replication (Items 3 to 9) exhibited a mean reporting of 71%, ranging from 42 to 96%.

Conclusion

Exercise training interventions for cancer survivors are incompletely reported across RCTs published between 2010 and 2017. The reporting of information about the provider, materials, and modifications require urgent improvements. Stronger reporting will enhance usability of trial reports by both healthcare providers and survivors, and will help to reduce research waste.

Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update

PURPOSE

Reporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines.

MATERIALS AND METHODS

Eight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).

RESULTS

Among the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines.

CONCLUSION

We conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.

Adherence to CONSORT Items in Randomized Controlled Trials of Integrative Medicine for Colorectal Cancer Published in Chinese Journals

BACKGROUND

The majority of studies of integrative treatment for colorectal cancer (CRC) have been published in Chinese journals. These studies indicate potential benefits, but concerns have been raised over the quality of trials published in Chinese journals. The CONSORT statement provides a guide for study reporting that has been endorsed by more than 400 international journals. Previous studies have used the CONSORT checklist to assess the quality of randomized controlled trials (RCTs).

OBJECTIVES

This study focused on RCTs of integrative and traditional medicine for CRC published in Chinese journals and assessed: (1) the overall quality of reporting with a focus on methodological aspects; (2) change over time; and (3) the influence of study funding, level of institution conducting the trial, rank of the journal, and the length of the article.

DESIGN

Searches of seven databases identified RCTs. Quality was assessed using CONSORT 2010 with adaptations to facilitate scoring. Additional codes were added for publication year, hospital rank, report length, and status of the journal. Scores of each checklist item, total scores, and scores for eight items associated with RCT methodology were calculated.

RESULTS

Eighty-one studies were included in the main analyses. The RCT methodology subgroup scores were significantly higher in studies: with public funding, conducted by authors from university hospitals, published in higher ranked journals, and in longer articles.

CONCLUSIONS

Few Chinese journals mention CONSORT in their author guidelines. In these RCTs on CRC better reporting of RCT methodology was associated with ranking of the journal as "core," public funding of the RCT, and first or correspondent author from a university hospital but the quality of reporting had not significantly improved in 15 years. As the volume of scientific information produced in China grows, it is imperative that there is growth in the quality of this information.

Acupuncture and related therapies used as add-on or alternative to prokinetics for functional dyspepsia: overview of systematic reviews and network meta-analysis

Prokinetics for functional dyspepsia (FD) have relatively higher number needed to treat values. Acupuncture and related therapies could be used as add-on or alternative. An overview of systematic reviews (SRs) and network meta-analyses (NMA) were performed to evaluate the comparative effectiveness of different acupuncture and related therapies. We conducted a comprehensive literature search for SRs of randomized controlled trials (RCTs) in eight international and Chinese databases. Data from eligible RCTs were extracted for random effect pairwise meta-analyses. NMA was used to explore the most effective treatment among acupuncture and related therapies used alone or as add-on to prokinetics, compared to prokinetics alone. From five SRs, 22 RCTs assessing various acupuncture and related therapies were included. No serious adverse events were reported. Two pairwise meta-analyses showed manual acupuncture has marginally stronger effect in alleviating global FD symptoms, compared to domperidone or itopride. Results from NMA showed combination of manual acupuncture and clebopride has the highest probability in alleviating patient reported global FD symptom. Combination of manual acupuncture and clebopride has the highest probability of being the most effective treatment for FD symptoms. Patients who are contraindicated for prokinetics may use manual acupuncture or moxibustion as alternative. Future confirmatory comparative effectiveness trials should compare clebopride add-on manual acupuncture with domperidone add-on manual acupuncture and moxibustion.

Efficacy of Human Papillomavirus L1 Protein Vaccines (Cervarix and Gardasil) in Reducing the Risk of Cervical Intraepithelial Neoplasia: A Meta-analysis

Human papillomavirus (HPV) can induce cervical intraepithelial neoplasia (CIN). Vaccination against HPV can play an important role in CIN prevention. This study aims to estimate the efficacy of L1 protein vaccines (Cervarix and Gardasil) in CIN 1, 2, 3 risk reduction using meta-analysis. Relevant articles were identified by two independent researchers searching international databanks. After application of inclusion/exclusion criteria and quality assessment, eligible articles were entered into the final meta-analysis. Inverse variance method and fixed effect model were used to combine the results of the primary studies. The heterogeneity between the results was assessed using Cochrane and I² indices. Of 11,530 evidence identified during the primary search, three papers were found eligible for meta-analysis, including 7213 participants in the intervention groups and 7170 healthy controls. The efficacy (95% confidence interval) of HPV 6, 11, 16, 18 monovalent and quadrivalent vaccines against CIN 1, CIN 2, and CIN 3 were estimated as of 95% (88–98), 97% (85–99), and 95% (78–99), respectively. This study showed that L1 protein vaccines Cervarix and Gardasil are highly protective vaccines playing an effective role in the prevention of HPV 6, 11, 16, 18 which are responsible for CIN 1, CIN 2, and CIN 3.

The effect of education on the anxiety of a family with a patient in critical care unit: a systematic review and meta-analysis

BACKGROUND

Studies have shown that family members of patients in intensive care units experience high levels of anxiety. Contradictions in the results of the studies conducted regarding the effect of training on the anxiety level of such families, emphasize the necessity of employing other research methods to eliminate these ambiguities.

OBJECTIVE

This study applied meta-analysis to determine the effect of training on the anxiety level of families with patients in the intensive care unit.

METHODS

In order to find electronically published studies from 1990 to 2016, the articles published in journals indexed in the following databases were used: Elsevier, Scopus, ProQuest, ISI, Web of Science, PubMed, Google scholar and Cochrane. For data analysis Stata Software version 11 was used and the heterogeneity index of studies was determined through Cochran (Q) and I². Due to the heterogeneity, the random effect model was used to estimate the difference between the standardized mean of anxiety.

RESULTS

In this meta-analysis and systematic review article, eight articles were found to be eligible. The number of samples in the initial studies into a meta-analysis included 387 patients in the intervention group and 393 people in the control group. Standardized difference of the mean anxiety score in the intervention group was -0.329 (CI 95%: -0.756-0.099) units less than that of the control group, indicating that this effect was not statistically significant.

CONCLUSIONS

The results of this meta-analysis show that training will decline the anxiety level of a family with patients hospitalized in the intensive care unit, although the impact is not considerable.

The Efficacy of Brucea javanica Oil Emulsion Injection as Adjunctive Therapy for Advanced Non-Small-Cell Lung Cancer: A Meta-Analysis

Purpose. To evaluate the efficacy of Brucea javanica oil emulsion injection (BJOEI) in patients with advanced non-small-cell lung cancer (NSCLC) during chemotherapy. Method. Electronic database of EMBASE and PubMed and the conference proceeding of ASCO, CNKI, CBMdisc, VIP, and Wanfang database were searched to select RCTs comparing BJOEI plus chemotherapy with chemotherapy alone in the treatment of advanced NSCLC, until June 1, 2016. Two reviewers independently performed the analysis according to the inclusion and exclusion criteria. Review Manager 5.3 and STATA 12.0 were employed for data analysis. Result. Twenty-one studies including 2234 cases were included. The pooled result indicated that there were significant differences in ORR (RR = 1.25; 95% CI: 1.14-1.36; P < 0.00001), improvement of QOL (RR = 1.87; 95% CI: 1.63-2.15; P < 0.00001), nausea and vomiting (RR = 0.67; 95% CI: 0.46-0.98; P = 0.04), leukopenia (RR = 0.63; 95% CI: 0.52-0.75; P < 0.00001), but there was no difference in thrombocytopenia (RR = 0.78; 95% CI: 0.49-1.23; P = 0.29). Begg's funnel plot and Egger's test indicated that no publication bias was found. The sensitivity analysis suggested the stability of the pooled result. Conclusion. The addition of BJOEI can enhance efficacy, improve QOL, and decrease incidence of nausea and vomiting and leukopenia for advanced NSCLC patients. However, higher quality RCTs are needed to further confirm this finding.

Chinese Herbal Medicine for Improving Quality of Life Among Nonsmall Cell Lung Cancer Patients: Overview of Systematic Reviews and Network Meta-Analysis

For patients with nonsmall cell lung cancer (NSCLC) receiving chemotherapy, current clinical evidence has indicated add-on benefit of Chinese herbal medicine (CHM) in improving quality of life (QoL). However, the relative performance among different CHM is unknown. The aim of this overview of systematic reviews (SRs) and network meta-analyses (NMA) is to evaluate the comparative effectiveness of different CHM. Seven electronic databases including both international databases and Chinese databases were searched. SRs focus on randomized controlled trials (RCTs) with comparison of CHM plus chemotherapy against chemotherapy alone on QoL among NSCLC patients were considered eligible. Data from RCTs were extracted for random effect pairwise meta-analyses. Pooled relative risk (RR) with 95% confidence interval (CI) was used to quantify the impact of CHM on QoL. NMA was used to explore the most effective CHM for improving QoL when used with chemotherapy. From 14 SRs, 61 RCTs (n = 4247) assessing 11 different CHM were included. Result from pairwise meta-analyses showed 6 CHM (Kang-lai-te injection, Shei-qi-fu-zheng injection, Compound ku-shen injection, Kang-ai injection, Zi-jin-long tablet, and Shen-fu injection) has significant beneficial effect on QoL among NSCLC patients when used with chemotherapy, even after adjustment for publication bias. Pooled RR varied from 1.38 (95% CI: 1.11-1.72, I2 = 0.0%, Kang-lai-te injection) to 3.36 (95% CI: 1.30-8.66, I2 = 0.0%, Zi-jin-long tablet). One trial comparing Hai-shen-su (a protein extract from Tegillarca granosa L.) plus chemotherapy with chemotherapy also demonstrated beneficial effect of combined treatment (RR = 3.13, 95% CI: 1.41-6.98). Results from NMA showed no differences on the comparative effectiveness among CHM, but Hai-shen-su plus chemotherapy has the highest probability (62.3%) of being the best option for improving QoL. Use of CHM on top of chemotherapy can significantly improve QoL in NSCLC patients. Although Hai-shen-su showed the highest probability of being the best add-on to chemotherapy, the effectiveness of all 11 CHM reviewed appeared to be similar. In the future, rigorous placebo controlled trials with proper blinding are needed to confirm the effectiveness of CHM.

Impact of the Consolidated Standards of Reporting Trials (CONSORT) checklist on reporting of randomized clinical trials in traditional Chinese medicine

OBJECTIVE

To examine the reporting characteristics and key methodological factors of randomized controlled trials (RCTs) in the field of traditional Chinese medicine and assess whether use of the Consolidated Standards of Reporting Trials (CONSORT) statement is associated with improvement in the quality of reports of RCTs.

METHOD

RCTs published in two major traditional Chinese medicine journals were retrieved and were systematically reviewed. Of those journals, one adopted the CONSORT statement (Journal of Chinese Integrative Medicine (JCIM)) and one did not (Chinese Journal of Integrative Medicine (CJIM)). Items within the CONSORT 2001 and the CONSORT 2010 statements were taken to develop a 63-item coding manual. The Jadad scale was also used to assess methodological quality of RCTs. Two observers assessed the reporting of reports and extracted data independently. P < 0.05 was considered statistically significant. SPSS was used for all analyses.

RESULTS

A total of 76 RCTs were included for the analysis (38 from JCIM and 38 from CJIM). Significant improvements both in the overall quality of reporting (CONSORT score) and reporting of methodological items (Jadad scale) over time were observed in adopter journal (JCIM) (P = 0.001). Overall CONSORT score of studies published during 2010 to 2011 (post-CONSORT) increased 15.30 averagely with 95%CI 8.34 to 22.26 (P = 0.001). Of those, items addressed on reporting of methodological quality were different significantly too. JCIM had more 1.30 items addressed than CJIM in average (95% CI 0.52 to 2.08, P = 0.003). In the multivariate analysis regression, the page length and CONSORT-promoting status have statistically significant associated with the (P = 0.001 and P = 0.040, respectively).

CONCLUSION

Although a large room needs to improve the reporting of randomized clinical trials in traditional Chinese medicine, the impact for improvement of reporting of TCM RCTs has been proven in some extent.

Is traditional Chinese medicine recommended in Western medicine clinical practice guidelines in China? A systematic analysis

BACKGROUND

Evidence-based medicine promotes and relies on the use of evidence in developing clinical practice guidelines (CPGs). The Chinese healthcare system includes both traditional Chinese medicine (TCM) and Western medicine, which are expected to be equally reflected in Chinese CPGs.

OBJECTIVE

To evaluate the inclusion of TCM-related information in Western medicine CPGs developed in China and the adoption of high level evidence.

METHODS

All CPGs were identified from the China Guideline Clearinghouse (CGC), which is the main Chinese organisation maintaining the guidelines issued by the Ministry of Health of China, the Chinese Medical Association and the Chinese Medical Doctors' Association.TCM-related contents were extracted from all the CPGs identified. Extracted information comprised the institution issuing the guideline, date of issue, disease, recommendations relating to TCM, evidence level of the recommended content and references supporting the recommendations.

RESULTS

A total of 604 CPGs were identified, only a small number of which (74/604; 12%) recommended TCM therapy and only five guidelines (7%) had applied evidence grading. The 74 CPGs involved 13 disease systems according to the International Classification of Diseases 10th edition. TCM was mainly recommended in the treatment part of the guidelines (73/74, 99%), and more than half of the recommendations (43/74, 58%) were related to Chinese herbal medicine (single herbs or herbal treatment based on syndrome differentiation).

CONCLUSIONS

Few Chinese Western medicine CPGs recommend TCM therapies and very few provide evidence grading for the TCM recommendation. We suggest that future guideline development should be based on systematic searches for evidence to support CPG recommendations and involve a multidisciplinary approach including TCM expertise.

Developing traditional chinese medicine in the era of evidence-based medicine: current evidences and challenges

Evidence-based medicine (EBM), by integrating individual clinical expertise with the best available clinical evidence from systematic research, has in recent years been established as the standard of modern medical practice for greater treatment efficacy and safety. Traditional Chinese Medicine (TCM), on the other hand, evolved as a system of medical practice from ancient China more than 2000 years ago based on empirical knowledge as well as theories and concepts which are yet to be mapped by scientific equivalents. Despite the expanding TCM usage and the recognition of its therapeutic benefits worldwide, the lack of robust evidence from the EBM perspective is hindering acceptance of TCM by the Western medicine community and its integration into mainstream healthcare. For TCM to become an integral component of the healthcare system so that its benefits can be rationally harnessed in the best interests of patients, it is essential for TCM to demonstrate its efficacy and safety by high-level evidence in accordance with EBM, though much debate remains on the validity and feasibility of applying the EBM model on this traditional practice. This review aims to discuss the current status of research in TCM, explore the evidences available on its efficacy and safety, and highlight the issues and challenges faced in applying EBM to TCM.