Article

Network meta-analyses could be improved by searching more sources and by involving a librarian

May 2014
Journal of Clinical Epidemiology 67(9)

DOI:10.1016/j.jclinepi.2014.04.003

Source
PubMed

Authors:

Lun Li

Central South University

Jinhui Tian

Lanzhou University

Show all 8 authorsHide

Objective: Network meta-analyses (NMAs) aim to rank the benefits (or harms) of interventions, based on all available randomized controlled trials. Thus, the identification of relevant data is critical. We assessed the conduct of the literature searches in NMAs. Study design: Published NMAs were retrieved by searching electronic bibliographic databases and other sources. Two independent reviewers selected studies and five trained reviewers abstracted data regarding literature searches, in duplicate. Search method details were examined using descriptive statistics. Results: Two hundred forty-nine NMAs were included. Eight used previous systematic reviews to identify primary studies without further searching, and five did not report any literature searches. In the 236 studies that used electronic databases to identify primary studies, the median number of databases was 3 (interquartile range: 3-5). MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were the most commonly used databases. The most common supplemental search methods included reference lists of included studies (48%), reference lists of previous systematic reviews (40%), and clinical trial registries (32%). None of these supplemental methods was conducted in more than 50% of the NMAs. Conclusion: Literature searches in NMAs could be improved by searching more sources, and by involving a librarian or information specialist.

Meta-análise de rede um guia para o clínico

Article

Full-text available

Apr 2025

Leonardo Roever

INTRODUÇÃO As revisões sistemáticas de ensaios controlados randomizados (ECRs) são geralmente consideradas o maior nível de evidência para eficácia relativa das intervenções 1-2. Meta-análise é uma técnica estatística para síntese quantitativa de estudos similares de uma revisão sistemática 1-3. A abordagem de meta-análise convencional é útil, mas é limitada na medida em que só podem comparar duas intervenções ao mesmo tempo 4-8. A meta-análise de rede (MAR) é uma extensão da meta-análise tradicional que permite comparar múltiplas intervenções simultaneamente, mesmo que não tenham sido diretamente comparadas em en-saios clínicos randomizados. A MAR utiliza dados de RESUMO Ameta-análise de rede (MAR) é uma técnica utilizada para com-parar múltiplos tratamentos simultaneamente em uma única análise combinando evidências diretas e indiretas dentro de uma rede de ensaios randomizados controlados. A MAR pode ajudar a avaliar a eficácia comparativa de diferentes tratamen tos regularmente utilizados na prática clínica. O objetivo deste trabalho é ilustrar o processo de metanálise de rede, para isto discutimos ospostos-chaves daMAR, bem como as considerações para o desenvolvendo de questões de pesquisa apropriadas, a condução darevisão da literatura, resumo de dados, síntese qualitativa e quantitativa, apresentação dos resultados, desenho da discussão e as conclusões de uma MRA. Descritores: Meta-análise de rede, comparações indiretas, com parações de tratamento misto, comparação de tratamento múltiplo, transitividade. comparações diretas (ensaios que comparam duas intervenções diretamente) e indiretas (inferências feitas com base em um conjunto comum de intervenções de controle. Ela é amplamente usada em pesquisas de saúde, especialmente para orientar decisões ba-seadas em evidências e diretrizes clínicas. Neste artigo, fornecemos um tutorial e discutiremos aspectos importantes da MAR. METODOLOGIA Trata-se de uma revisão narrativa, em que se rea-lizou um levantamento bibliográfico centrado em ar tigos publicados em periódicos científicos indexados nos bancos de dados MedlineEuropubmed, Scopus,

Is high intensity laser therapy more effective than other physical therapy modalities for treating knee osteoarthritis? A systematic review and network meta-analysis

Article

Full-text available

Sep 2022

Background The use of physical therapy modalities, especially high intensity laser therapy (HILT), for individuals with knee osteoarthritis (KOA) is still controversial. Objective To compare the effects of HILT to other physical therapy modalities on symptoms and function in individuals with KOA. Methods Six databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, and PEDro) were searched in March 2022. Included studies were randomized controlled trials involving HILT conducted on individuals with KOA. The end-trial weighted mean difference (WMD) and standard deviations (SD) with 95% confidence intervals (CI) were analyzed. Results Ten studies with 580 participants were obtained, of which nine were included in the final network meta-analysis. In terms of relieving pain, HILT demonstrated the highest probability of being among the most effective treatments, with surface under the cumulative ranking (SUCRA) = 100%, and compared to a control (placebo laser or exercise or a combination of both) on the visual analog scale (VAS) for pain it demonstrated significant benefits (WMD 1.66, 95% CI 1.48–1.84). For improving self-reported function, as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores, the HILT SUCRA value led with 98.9%. When individuals with KOA were treated by HILT, the improvement in stiffness was statistically significant (WMD 0.78, 95% CI 0.52–1.04) but the amount of improvement was smaller than the minimal clinically important difference (MCID). Conclusion The current evidence suggests that HILT may be more effective than other physical therapy modalities for improving pain and function in individuals with KOA. For improving stiffness, however, it may not be clinically effective. Systematic review registration [ https://www.researchregistry.com ], identifier [1148].

Mechanism of Fuzheng Kang’ai Formula (扶正抗癌方) Regulating Tumor Microenvironment in Non-Small Cell Lung Cancer

Article

Full-text available

Sep 2021

Objective To study the mechanism of Chinese herbal medicine Fuzheng Kang’ai Formula (扶正抗癌方, FZKA) on tumor microenvironment (TME).MethodsCIBERSORTx was used for analysis of TME. Traditional Chinese Medicine Systems Pharmacology and Analysis Platform was applied to identify compounds-targets network and the Cancer Genome Atlas (TCGA) was employed to identify the differential expression genes (DEGs) between tumor and paracancerous tissues in lung adenocarcinoma (LUAD) from TCGA-LUAD. Additionally, DEGs with prognosis in LUAD was calculated by univariable and multivariate Cox regression. The core targets of FZKA were analyzed in lung adenocarcinoma TME. Protein-protein interaction database was employed to predict down-stream of target. Quantitative reverse transcription polymerase chain reaction was employed for biological experiment in A549, H1299 and PC9 cell lines.ResultsThe active and resting mast cells were significantly associated with prognosis of LUAD (P<0.05). Of the targets, CCNA2 as an important target of FZKA (hazard ratio=1.41, 95% confidential interval: 1.01–2.01, P<0.05) was a prognostic target and significantly associated with mast cells. CCNA2 was positively correlated with mast cell activation and negatively correlated with mast cell resting state. BCL1L2, ACTL6A and ITGAV were down-stream of CCNA2, which were validated by qRT-PCR in A549 cell.ConclusionFZKA could directly bind to CCNA2 and inhibit tumor growth by regulating CCNA2 downstream genes and TME of NSCLC closely related to CCNA2.

Efficacy of scrambler therapy in chronic neuropathic pain: pairwise and dose-response meta-analysis

Article

Full-text available

Sep 2024

Chronic neuropathic pain (CNP) affects 7% of the world’s population and is challenging to control since existing medications are inadequate and have negative effects. Electrocutaneous devices, such as scrambler therapy (ST), have emerged as a possible option and have shown promising results in multiple randomized controlled trials (RCTs). However, the long-term efficacy of ST remains unknown. We aimed to evaluate the efficacy of ST in CNP reduction over time. We used the data sources including PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials from inception to September 2023. Five placebo and three routine-care controlled RCTs were selected among the screened abstracts. Two authors independently extracted the data. Data was pooled using a model under the common parameters assumption. The studies were evaluated for methodological quality using the MethodologicAl STandard for Epidemiological Research (MASTER) scale. The primary outcome measure was pain reduction; pain was converted to a common 0 to 10 scale, and a weighted mean difference of more than 2 points on a 10-point pain scale was considered clinically important. Eight RCTs that evaluated the effect of ST on CNP were included, with a total sample size of 350 participants. None of the participants withdrew in all these trials owing to adverse events or lack of efficacy. There was high-quality evidence that ST reduced pain in the short term, with a mean difference of –3 points. The dose-response meta-analysis demonstrated a significant reduction in pain scores post-treatment, with a peak reduction at day 40. The effect of ST remained below the baseline values for 90 days, although with limited certainty. This study is the first dose-response meta-analysis to assess the duration of efficacy of ST in the treatment of CNP. The results demonstrated a clinically significant and more sustained reduction in pain created by ST compared to conventional treatments. Our findings indicate that ST could be used as a safe and effective alternative for managing CNP.

What do journals' author instructions state on search methods for systematic reviews: from evidence to implementation.

Poster

Full-text available

Sep 2024

Guidance for systematic reviews in journal author instructions: Findings and recommendations for editorial teams

Article

Full-text available

Mar 2024

Introduction Systematic reviews play a crucial role in informing clinical decision‐making, policy formulation, and evidence‐based practice. However, despite the existence of well‐established guidelines, inadequately executed and reported systematic reviews continue to be published. These highly cited reviews not only pose a threat to the credibility of science but also have substantial implications for medical decision‐making. This study aims to evaluate and recommend improvements to the author instructions of biomedical and health journals concerning the conducting and reporting of systematic reviews. Methods A sample of 168 journals was selected based on systematic reviews published between 2020 and 2021, taking into account their Altmetric attention score, citation impact, and mentions in Altmetric Explorer. Author instructions were downloaded, and data extraction was carried out using a standardized web form. Two reviewers independently extracted data, and discrepancies were resolved by a third reviewer. The findings were presented using descriptive statistics, and recommendations for editorial teams were formulated. The protocol is registered with the Open Science Framework Registries (osf. io/bym8d). Results One‐third of the journals lack tailored guidance for systematic reviews, as demonstrated by the absence of references to conducting or reporting guidelines, protocol registration, data sharing, and the involvement of an information specialist. Half of the author instructions do not include a dedicated section on systematic reviews, hampering the findability of tailored information. The involvement of information specialists is seldom acknowledged. Ultimately, the absence of an update date in most author instructions raises concerns about the incorporation of the most recent developments and tools for systematic reviews. Conclusion Journals that make substantial contributions to synthesizing evidence in biomedicine and health are missing an opportunity to provide clear guidance within their author instructions regarding the conducting and reporting of reliable systematic reviews. This not only fails to inform future authors but also potentially compromises the quality of this frequently published research type. Furthermore, there is a need for greater recognition of the added value of information specialists to the systematic review and publishing processes. This article provides recommendations drawn from the study's observations, aiming to help editorial teams enhance author instructions and, consequently, potentially assisting systematic reviewers in improving the quality of their reviews.

Investigate the relationship between the retraction reasons and the quality of methodology in non-Cochrane retracted systematic reviews: a systematic review

Article

Full-text available

Jan 2024

Background This systematic review aimed to investigate the relationship between retraction status and the methodology quality in the retracted non-Cochrane systematic review. Method PubMed, Web of Science, and Scopus databases were searched with keywords including systematic review, meta-analysis, and retraction or retracted as a type of publication until September 2023. There were no time or language restrictions. Non-Cochrane medical systematic review studies that were retracted were included in the present study. The data related to the retraction status of the articles were extracted from the retraction notice and Retraction Watch, and the quality of the methodology was evaluated with the AMSTAR-2 checklist by two independent researchers. Data were analyzed in the Excel 2019 and SPSS 21 software. Result Of the 282 systematic reviews, the corresponding authors of 208 (73.75%) articles were from China. The average interval between publish and retraction of the article was about 23 months and about half of the non-Cochrane systematic reviews were retracted in the last 4 years. The most common reasons for retractions were fake peer reviews and unreliable data, respectively. Editors and publishers were the most retractors or requestors for retractions. More than 86% of the retracted non-Cochrane SRs were published in journals with an impact factor above two and had a critically low quality. Items 7, 9, and 13 among the critical items of the AMSTAR-2 checklist received the lowest scores. Discussion and conclusion There was a significant relationship between the reasons of retraction and the quality of the methodology (P-value < 0.05). Plagiarism software and using the Cope guidelines may decrease the time of retraction. In some countries, strict rules for promoting researchers increase the risk of misconduct. To avoid scientific errors and improve the quality of systematic reviews/meta-analyses (SRs/MAs), it is better to create protocol registration and retraction guidelines in each journal for SRs/MAs.

Methodological quality of systematic reviews in dentistry including animal studies: a cross-sectional study

Article

Full-text available

Dec 2023
IRISH VET J

Background The overall confidence in the results of systematic reviews including animal models can be heterogeneous. We assessed the methodological quality of systematic reviews including animal models in dentistry as well as the overall confidence in the results of those systematic reviews. Material & methods PubMed, Web of Science and Scopus were searched for systematic reviews including animal studies in dentistry published later than January 2010 until 18th of July 2022. Overall confidence in the results was assessed using a modified version of the A MeaSurement Tool to Assess systematic Reviews (AMSTAR-2) checklist. Checklist items were rated as yes , partial yes , no and not applicable . Linear regression analysis was used to investigate associations between systematic review characteristics and the overall adherence to the AMSTAR-2 checklist. The overall confidence in the results was calculated based on the number of critical and non-critical weaknesses presented in the AMSTAR-2 items and rated as high, moderate, low and critical low. Results Of initially 951 retrieved systematic reviews, 190 were included in the study. The overall confidence in the results was low in 43 (22.6%) and critically low in 133 (70.0%) systematic reviews. While some AMSTAR-2 items were regularly reported (e.g. conflict of interest, selection in duplicate), others were not (e.g. funding: n = 1; 0.5%). Multivariable linear regression analysis showed that the adherence scores of AMSTAR-2 was significantly associated with publication year, journal impact factor (IF), topic, and the use of tools to assess risk of bias (RoB) of the systematic reviews. Conclusion Although the methodological quality of dental systematic reviews of animal models improved over the years, it is still suboptimal. The overall confidence in the results was mostly low or critically low. Systematic reviews, which were published later, published in a journal with a higher IF, focused on non-surgery topics, and used at least one tool to assess RoB correlated with greater adherence to the AMSTAR-2 guidelines.

The effects of active workstations on reducing work-specific sedentary time in office workers: a network meta-analysis of 23 randomized controlled trials

Article

Full-text available

Jul 2023
INT J BEHAV NUTR PHY

Background Active workstations have been proposed as a feasible approach for reducing occupational sedentary time. This study used a network meta-analysis (NMA) to assess and compare the overall efficacy of active workstation interventions according to type and concomitant strategy for reducing work-specific sitting time in office workers. Methods PubMed, Web of Science, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched from database inception until May 2022 to obtain randomized controlled trials (RCTs) assessing the efficacy of active workstations with or without concomitant strategies for reducing occupational sedentary time in office workers. The risk of bias of the RCTs included in this study was assessed according to the Cochrane Handbook. An NMA with STATA 15.1 was used to construct a network diagram, league figures, and the final surface under the cumulative ranking curve (SUCRA) values. The certainty of evidence was assessed using the grading of recommendations, assessment, development, and evaluation (GRADE) approach. Results A total of 23 eligible studies including eight different types of interventions with 1428 office workers were included. NMA results showed that compared to a typical desk, multicomponent intervention (standardized mean difference (SMD) = − 1.50; 95% confidence interval (CI) − 2.17, − 0.82; SUCRA = 72.4%), sit-stand workstation + promotion (Reminders of rest breaks, posture variation, or incidental office activity) (SMD = − 1.49; 95%CI − 2.42, − 0.55; SUCRA = 71.0%), treadmill workstation + promotion (SMD = − 1.29; 95%CI − 2.51, − 0.07; SUCRA = 61.6%), and sit-stand workstation (SMD = − 1.10, 95%CI − 1.64, − 0.56; SUCRA = 50.2%) were effective in reducing occupational sedentary time for office workers. Conclusions Multicomponent intervention, sit-stand workstation + promotion, treadmill workstation + promotion, and sit-stand workstation appear to be effective in reducing work-specific sedentary time for office workers. Furthermore, multicomponent interventions and active workstations + promotion better reduced work-specific sedentary time than active workstation alone. However, the overall certainty of the evidence was low. Trial registration Our study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO); registration number: CRD42022344432.

Reporting standards for child health research were few and poorly Implemented

Article

Mar 2023
J CLIN EPIDEMIOL

Objectives: This study aims to identify existing reporting standards for child health research, assess the robustness of the standards development process, and evaluate the dissemination of these standards. Study design and setting: We searched MEDLINE, the EQUATOR Network Library and Google to identify reporting standards for child health research studies. We assessed the adherence of the Guidance for Developers of Health Research Reporting Guidelines (GDHRG) by the identified reporting standards. We also assessed the use of the identified reporting standards by primary research studies, and the endorsement of the included reporting standards by journals. Results: We identified six reporting standards for child health research, including two under development. Among the four available standards, their median adherence to the 18 main steps of the GDHRG was 58.35% (range: 27.8%-83.3%). None of these four reporting standards had been endorsed by pediatric journals indexed by the Science Citation Index. Only 26 primary research studies declared that they followed one of the reporting standards. Conclusion: There is a quantitative and qualitative paucity of well-developed reporting standards for child health research. The available standards are also poorly implemented. This situation demands an urgent need to develop robust standards and ensure their implementation.

Exploring cultural determinants to be integrated into preterm infant care in the neonatal intensive care unit: an integrative literature review

Article

Full-text available

Jan 2023

Background Cultural practices are an integral part of childrearing and remain a significant aspect for healthcare professionals to ensure culturally sensitive care, particularly in the neonatal intensive care unit. Objective To synthesise literature on the cultural determinants that can be integrated into care of preterm infants admitted into the neonatal intensive care unit. Methods The current review followed the integrative literature review steps proposed by Lubbe and colleagues. The registration of the review protocol was in PROSPERO . There was a literature search conducted in the EBSCOhost, PubMed, ScienceDirect and Scopus databases using the search string developed in collaboration with the librarian. Three reviewers employed a three-step screening strategy to screen the articles published in English between 2011 and 2021 that focused on culturally sensitive care. The Johns Hopkins Nursing Evidence-Based Practice Evidence critical appraisal toolkit assessed the methodological quality of the articles included at the full-text screening level. Results There were 141 articles retrieved, and 20 included on the full-text screening level; the exclusion of one article was due to a low critical appraisal grade. Four topical themes emerged from 19 articles: spiritual care practices, intragenerational infant-rearing practices, infant physical care practices, and combining treatment practices. Conclusion Overall, the findings indicated that parental cultural beliefs and practices mostly influenced infant-rearing practices, emphasising the significance of integrating cultural practices when rendering healthcare services. The recommendation is that healthcare professionals understand various cultural determinants, mainly those specific to the community they serve, to provide culturally sensitive care.

A protocol for establishing a core outcome set for studies examining treatments for Problematic Internet use

Preprint

Full-text available

Sep 2022

Background Randomised controlled trials (RCTs) evaluating Problematic internet use (PIU) have reported many different outcomes, which are themselves often defined and measured in distinct ways. Numerous clinical trials have been conducted on the efficacy and safety of different interventions in the treatment of PIU, resulting in many different outcome measures and different ways of measuring them. In order to facilitate the future research of PIU, it is necessary to produce the core Outcome Set (COS), which can help to translate the results into high-quality evidence. Methods and analysis: This mixed-method project has a three-phase tool: Phase 1, a scoping review of the literature to identify outcomes that have been reported in clinical trials and systematic reviews of interventions for PIU. Phase 2, a systematic review of PIU literature was conducted to identify potential outcome indicators. Phase 3, final outcome indicators were determined through Modified Delphi Method, Consensus Meetings, Stakeholder Perspectives and Stakeholder Consultations. Conclusions We will develop a COS that should be reported in future clinical trials of PIU. Trial registration: Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: www.comet-initiative.org/Studies/Details/2109. Registered in August 2022.

A Tailored Approach: A model for literature searching in complex systematic reviews

Article

Full-text available

Sep 2022
J INF SCI

Our previous work identified that nine leading guidance documents for seven different types of systematic review advocated the same process of literature searching. We defined and illustrated this process and we named it ‘the Conventional Approach’. The Conventional Approach appears to meet the needs of researchers undertaking literature searches for systematic reviews of clinical interventions. In this article, we report a new and alternate process model of literature searching called ‘A Tailored Approach’. A Tailored Approach is indicated as a search process for complex reviews which do not focus on the evaluation of clinical interventions. The aims of this article are to (1) explain the rationale for, and the theories behind, the design of A Tailored Approach; (2) report the current conceptual illustration of A Tailored Approach and to describe a user’s interaction with the process model; and (3) situate the elements novel to A Tailored Approach (when compared with the Conventional Approach) in the relevant literature. A Tailored Approach suggests investing time at the start of a review, to develop the information needs from the research objectives, and to tailor the search approach to studies or data. Tailored Approaches should be led by the information specialist (librarian) but developed by the research team. The aim is not necessarily to focus on comprehensive retrieval. Further research is indicated to evaluate the use of supplementary search methods, methods of team-working to define search approaches, and to evaluate the use of conceptual models of information retrieval for testing and evaluation.

Is the quality of systematic reviews influenced by prospective registration: a methods review of systematic musculoskeletal physical therapy reviews

Article

Aug 2022

Introduction: It is unknown if verified prospective registration of systematic reviews (SRs) and the randomized clinical trials (RCTs) that they use affect an SR's methodological quality on A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Methods: Data originated from interventional SRs published in International Society of Physiotherapy Journals Editors (ISPJE) member journals, indexed in MEDLINE, between 1 January 2018 and 18 August 2021. Blinded reviewers identified the SRs and extracted the data for the variables of interest for the SRs and the RCTs. Results: Two of 14 ISPJE member journals required prospective SR registration. Twenty SRs were identified, and 169 unique, retrievable RCTs were included within those SRs. One (5.0%) of the 20 SRs and 15 of the 169 (8.9%) RCTs were prospectively registered and published consistent with this intent. Nineteen (95.0%) of the 20 identified SRs was categorized as 'critically low' on the AMSTAR 2. Discussion: SRs and the RCTs identified within them were infrequently prospectively registered, prospectively verifiable, or prospectively verified based on the established research record. Conclusions: Ensuring that SRs and RCTs have fidelity with the research record from conception to publication may help rule out low-value interventions, decrease variability in physical therapy practice, and solidify evidence-based physical therapy practice.

Methodology and experiences of rapid advice guideline development for children with COVID-19: responding to the COVID-19 outbreak quickly and efficiently

Article

Full-text available

Apr 2022
BMC MED RES METHODOL

Background Rapid Advice Guidelines (RAG) provide decision makers with guidance to respond to public health emergencies by developing evidence-based recommendations in a short period of time with a scientific and standardized approach. However, the experience from the development process of a RAG has so far not been systematically summarized. Therefore, our working group will take the experience of the development of the RAG for children with COVID-19 as an example to systematically explore the methodology, advantages, and challenges in the development of the RAG. We shall propose suggestions and reflections for future research, in order to provide a more detailed reference for future development of RAGs. Result The development of the RAG by a group of 67 researchers from 11 countries took 50 days from the official commencement of the work (January 28, 2020) to submission (March 17, 2020). A total of 21 meetings were held with a total duration of 48 h (average 2.3 h per meeting) and an average of 16.5 participants attending . Only two of the ten recommendations were fully supported by direct evidence for COVID-19, three recommendations were supported by indirect evidence only, and the proportion of COVID-19 studies among the body of evidence in the remaining five recommendations ranged between 10 and 83%. Six of the ten recommendations used COVID-19 preprints as evidence support, and up to 50% of the studies with direct evidence on COVID-19 were preprints. Conclusions In order to respond to public health emergencies, the development of RAG also requires a clear and transparent formulation process, usually using a large amount of indirect and non-peer-reviewed evidence to support the formation of recommendations. Strict following of the WHO RAG handbook does not only enhance the transparency and clarity of the guideline, but also can speed up the guideline development process, thereby saving time and labor costs.

Effectiveness and safety of electrical stimulation for treating pressure ulcers: A systematic review and meta‐analysis

Article

Full-text available

Mar 2022
Int J Nurs Pract

Aim This study aims to synthesize qualitative evidence on the effectiveness and safety of electrical stimulation for treating pressure ulcers. Background Electrical stimulation is often used clinically to treat pressure ulcers, but its effectiveness and safety and some potential problems are not clear. Design This is a qualitative systematic review. Data Sources The data sources are four English databases (PubMed, EMBASE, The Cochrane Library and Web of Science) and four Chinese databases (CNKI, SinoMed, VIP and WANFANG). Methods Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. We used the Review Manager 5.3 software to perform data analysis. Results Seventeen randomized controlled trials including 740 patients were included in this study. Meta‐analysis of eight randomized controlled trials demonstrated that electrical stimulation significantly reduced the ulcer surface in contrast with standard wound care alone or pulsed sham electrical stimulation. Nine studies showed that electrical stimulation increased the risk of pressure ulcers being completely healed than the controlled group. Three studies reported that adverse reactions were rare. Conclusions This study demonstrated that electrical stimulation was a relatively effective and safe adjunctive therapy for pressure ulcers treatment.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis: A systematic review and meta-analysis

Article

Full-text available

Jan 2022

Background: As a serious global problem, knee osteoarthritis (KOA) often leads to pain and disability. Manual therapy is widely used as a kind of physical treatment for KOA. Aim: To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA. Methods: We searched PubMed, the Cochrane Library, EMbase, Web of Science and Google Scholar from inception to September 20, 2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA. The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials. Data analyses were performed using Review Manager 5.0 software. Results: A total of 341 articles were screened from five electronic databases (PubMed, the Cochrane Library, EMbase, Web of Science and Google Scholar) after excluding duplicates. Ultimately, eight trials involving 471 subjects were included in present systematic review and meta-analysis. The mean PEDro scale score was 6.6. Mulligan mobilization was more effective in alleviating pain [standardized mean difference (SMD) = 0.60; 95% confidence interval (CI): 0.17 to 1.03, P = 0.007; I 2 = 60%, P = 0.020) and improving Western Ontario and McMaster Universities function score (SMD = 7.41; 95%CI: 2.36 to 12.47, P = 0.004; I 2 = 92%, P = 0.000). There was no difference in the effect of the two kinds of mobilization on improving the range of motion (SMD = 9.63; 95%CI: -1.23 to 20.48, P = 0.080; I 2 = 97%, P = 0.000). Conclusion: Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

Computer-assisted cannulated screw internal fixation versus conventional cannulated screw internal fixation for femoral neck fractures: a systematic review and meta-analysis

Article

Full-text available

Nov 2021
J Orthop Surg Res

Objective: To compare the effects between computer-assisted and traditional cannulated screw internal fixation on treating femoral neck fracture. Methods: The search was conducted in Embase, Pubmed, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database from the beginning to August 2020. RevMan5.4 software, which was provided by the International Cochrane Group, was used for the meta-analysis comparing the differences in operation time, intraoperative bleeding volume, fluoroscopy frequency, fracture healing time, total drilling times, Harris score, fracture healing rate, and femoral head necrosis rate between computer-assisted and traditional methods groups. Results: A total of 1028 patients were included in 16 studies. Primary outcome indicators: Compared with the traditional method group, the computer-assisted group had less operative time (2RCTs, P < 0.00001; 8 non-RCTs, P = 0.009; Overall, P < 0.00001), intraoperative bleeding (1 RCTs, P < 0.00001; 9non-RCTs, P < 0.00001; Overall, P < 0.00001), femoral head necrosis rate (1 RCT, P = 0.11;7 non-RCTs, P = 0.09; Overall, P = 0.02) and higher Harris scores (1 RCT, P < 0.0001; 9 non-RCTs, P = 0.0002; Overall, P < 0.0001), and there were no significant differences in fracture healing rate between the two groups (5 non-RCTs, P = 0.17). Secondary outcomes indicators: The computer-assisted group had a lower frequency of intraoperative fluoroscopy and total number of drills compared with the traditional method group, while there was no significant difference in fracture healing time. Conclusion: Compared with the traditional hollow screw internal fixation on the treatment of femoral neck fracture, computer-assisted percutaneous cannulated screw fixation can shorten the operation time and improve the operation efficiency and reduce the X-ray injury of medical staff and help patients obtain a better prognosis. Therefore, computer-assisted percutaneous cannulated screw fixation is a better choice for the treatment of femoral neck fracture. Study registration PROSPERO registration number CRD42020214493.

Network meta-analysis for clinicians

Article

Full-text available

Nov 2021

Decision making in clinical practice requires consideration of the relative efficacy and safety of medical interventions. A systematic review and meta-analysis, the results of which have the highest level of confidence in evidence-based medicine, only compare the effectiveness of two interventions, provided that there is a direct comparison between them in a set of randomized controlled trials. The development of statistical methods has led to the development of the network meta-analysis method, the application of which allows comparison for more than two interventions and even if the interventions were not directly compared in randomized controlled trials, but have a common comparison intervention. As a result, network meta-analysis is increasingly being used as an evidence base for the effectiveness of medical interventions. However, there are important assumptions and conditions underlying the performance of network meta-analysis. In this work, we tried to outline the main aspects of network meta-analysis that are important for clinicians in terms of its implementation and interpretation of its results.

Risk factors for poor prognosis in children and adolescents with COVID-19: A systematic review and meta-analysis

Article

Full-text available

Nov 2021

Background This study provides the first systematic review and meta-analysis to identify the predictors of unfavorable prognosis of COVID-19 in children and adolescents. Methods We searched literature databases until July 2021 for studies that investigated risk factors for unfavorable prognosis of children and adolescents with COVID-19. We used random-effects models to estimate the effect size with 95% confidence interval (CI). Findings We identified 56 studies comprising 79,104 individuals. Mortality was higher in patients with multisystem inflammatory syndrome (MIS-C) (odds ratio [OR]=58.00, 95% CI 6.39–526.79) and who were admitted to intensive care (OR=12.64, 95% CI 3.42–46.68). Acute respiratry distress syndrme (ARDS) (OR=29.54, 95% CI 12.69–68.78) and acute kidney injury (AKI) (OR=55.02, 95% CI 6.26–483.35) increased the odds to be admitted to intensive care; shortness of breath (OR=16.96, 95% CI 7.66–37.51) increased the need of respiratory support; and neurological diseases (OR=5.16, 95% CI 2.30–11.60), C-reactive protein (CRP) level ≥80 mg/L (OR=11.70, 95% CI 4.37–31.37) and D-dimer level ≥0.5ug/mL (OR=20.40, 95% CI 1.76–236.44) increased the odds of progression to severe or critical disease. Interpretation Congenital heart disease, chronic pulmonary disease, neurological diseases, obesity, MIS-C, shortness of breath, ARDS, AKI, gastrointestinal symptoms, elevated CRP and D-dimer are associated with unfavourable prognosis in children and adolescents with COVID-19.

Progress and challenges of network meta‐analysis

Article

Full-text available

Aug 2021

In the past years, network meta‐analysis (NMA) has been widely used among clinicians, guideline makers, and health technology assessment agencies and has played an important role in clinical decision‐making and guideline development. To inform further development of NMAs, we conducted a bibliometric analysis to assess the current status of published NMA methodological studies, summarized the methodological progress of seven types of NMAs, and discussed the current challenges of NMAs.

Clinical Epidemiology in China series. Paper 4: The reporting and methodological quality of Chinese clinical practice guidelines published between 2014 and 2018: A Systematic Review

Article

Aug 2021
J CLIN EPIDEMIOL

Objectives This study aimed to systematically review the methodological and reporting quality of clinical practice guidelines (CPGs) developed in China and published in medical journals between 2014 and 2018. Study Design and Setting We conducted a comprehensive search in multiple databases: MEDLINE (via PubMed), Embase, CBM (China Biology Medicine), CNKI (China National Knowledge Infrastructure) and Wanfang Data. We included all clinical practice guidelines developed in China between 2014 and 2018. The AGREE II tool and the RIGHT checklist were used to appraise the methodological quality and reporting quality of the included guidelines, respectively. Results We identified 17,188 records, and included finally 573 CPGs. Most (n=507, 88.5%) were published in Chinese, and 508 (88.7%) were about Western medicine. Only 62 (10.8%) of the guidelines used the GRADE approach. The mean overall score of methodological quality over all guidelines was 19.4%, and the mean scores for the AGREE II domains were 28.6% (Scope and purpose), 17.0% (Stakeholder involvement), 11.7% (Rigor of development), 32.2% (Clarity of presentation), 14.2% (Applicability) and 12.8% (Editorial independence). The mean overall score for reporting quality over all guidelines was 30.2%, with the following mean scores for each RIGHT domain: 55.6% (Basic information), 43.8% (Background), 14.5% (Evidence), 29.2% (Recommendations), 10.7% (Review and quality assurance), 12.6% (Funding and declaration of interest) and 8.4% (Other information). Subgroup analyses found that both the methodological and reporting quality were generally higher among CPGs that used evidence grading systems or reported receiving funding. Conclusion Both the methodological quality and the reporting quality of CPGs developed in China have improved over time, but are still below the international average.

More Consideration is Needed for Retracted Non-Cochrane Systematic Reviews in Medicine: A Systematic Review

Article

Full-text available

Jun 2021
J CLIN EPIDEMIOL

Objective: To analyze the retraction status and reasons of non-Cochrane systematic reviews (SRs) in medicine. Study design and setting: MEDLINE, Embase, Retraction Watch Database and Google Scholar were systematically searched to find all retracted non-Cochrane SRs. Results: Of 159 non-Cochrane SRs in medicine retracted between 2004 and 2020, more than 70% were led by authors from China and affiliated with hospitals. The largest proportion of retraction notices were issued by the publisher and editor(s) jointly. Fraudulent peer-review was the most common reason for retraction, followed by unreliable data meaning errors in study selection or data analysis. The median time between publication and retraction was 14 months, and SRs retracted due to research misconduct took longer to retract than honest error. Conclusion: The total number of retracted SRs is increasing worldwide, in particular in China. The most common reasons for retraction are fraudulent peer-review and unreliable data, and in most cases the SR is retracted more than a year after publication. Better systems of ethical oversight and culture to improve the process of peer review and adherence to the COPE retraction guidance are needed, and authors should strengthen their skills in SR methodology.

Sildenafil for Asian Adult Patients with Pulmonary Arterial Hypertension: A Systematic Review and Meta-analysis

Preprint

Full-text available

May 2021

Background: The prognosis of patients with untreated pulmonary arterial hypertension (PAH) has historically been poor. Previous studies have recommended that sildenafil was beneficial, but the dose varies greatly. We aimed to evaluate sildenafil effectiveness and safety in dose of 20mg/three times a day (TID) for Asian adult patients with PAH. Methods: Electronic databases (MEDLINE, Embase, Web of Science, the Cochrane Library, CBM, CNKI and Wanfang Data) from their inception to May 2020 were searched. We included all randomized controlled trials and non-randomized studies of interventions that comparing sildenafil (20mg/TID) versus placebo or symptomatic treatment for PAH Asian adults. Results: Eight studies totaling 364 participants were included. When compared to symptomatic treatment, sildenafil treated patients were more likely to walk 68.3 meters further in six-minute walk distance [mean difference (MD)=68.3 meters, 95% confidence interval (CI) 48.85 to 87.76, P＜0.00001], to achieve an improvement in systemic arterial oxygen saturation (MD=2.48%, 95% CI 1.26 to 3.71, P＜0.00001) and in score on the Borg scale of dyspnea (MD=-0.99 points, 95% CI -1.45 to -0.53, P＜0.00001). The total number of patients with WHO class III and IV also showed downtrend. When compared to placebo, sildenafil was associated with a greater reduction in the mean pulmonary artery pressure (MD=-4.13 mmHg, 95% CI -6.52 to -1.74, P=0.0007) and level of brain natriuretic peptide (MD=-86.16 pg /mL, 95% CI -103.39 to -68.93, P＜0.00001). The most adverse reactions were headache, flushing, dyspepsia, and diarrhea, which were relatively mild. Conclusions: Sildenafil in dose of 20mg/TID is well tolerated in Asian adults with PAH, and associated with statistically significant improvements in exercise capacity, cardio-pulmonary function and haemodynamic indices. The long-term prognosis still needs to be evaluated and confirmed by further trials. Systematic review registration: PROSPERO CRD42020190582

Quality and consistency of clinical practice guidelines for treating children with COVID-19

Article

Full-text available

Apr 2021

Background: The Coronavirus Disease 2019 (COVID-19) pandemic negatively affects children's health. Many guidelines have been developed for treating children with COVID-19. The quality of the existing guidelines and the consistency of recommendations remains unknown. Therefore, we aim to review the clinical practice guidelines (CPGs) for children with COVID-19 systematically. Methods: We systematically searched Medline, Embase, guideline-related websites, and Google. The Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool and Reporting Items for practice Guidelines in HealThcare (RIGHT) checklist were used to evaluate the methodological and reporting quality of the included guidelines, respectively. The consistency of recommendations across the guidelines and their supporting evidence were analyzed. Results: Twenty guidelines were included in this study. The mean AGREE II score and mean RIGHT reporting rate of the included guidelines were 37% (range, 22-62%) and 52% (range, 31-89%), respectively. As for methodological quality, no guideline was classified as high, one guideline (5%) moderate, and 19 (95%) low. In terms of reporting quality, one guideline (5%) was rated as high, 12 guidelines (60%) moderate, and seven (35%) low. Among included guidelines, recommendations varied greatly in the use of remdesivir (recommend: 25%, not recommend: 45%, not report: 30%), interferon (recommend: 15%, not recommend: 50%, not report: 35%), glucocorticoids (recommend: 50%, not recommend: 20%, not report: 30%), and intravenous immune globulin (recommend: 35%, not recommend: 30%, not report: 35%). None of the guidelines cited clinical trials from children with COVID-19. Conclusions: The methodological and reporting quality of guidelines for treating children with COVID-19 was not high. Recommendations were inconsistent across different guidelines. The supporting evidence from children with COVID-19 was very limited.

CHLA Standards for Library and Information Services in Canadian Health & Social Services Institutions 2020

Article

Full-text available

Apr 2021

The following standards, with supporting evidence, are intended to serve as a guide to structuring minimum library services within health and social services institutions across all Canadian provinces and territories. The Standards are not intended to be aspirational. The aim of the Canada Health Libraries Association (CHLA) Task Force was to ensure that the Standards update would not be so removed from the current realities and landscape that they became unattainable to many libraries. For this reason, some Standards outline requirements that are essential to the minimum function of the library, and other Standards provide recommendations only. The intended use of the Standards is to set a baseline for the provision of essential library services and resources and aid in advocating for adequate resources. It is important to note, however, that the CHLA Task Force does not intend for the Standards to prevent libraries from reaching a more advanced level of service, and we hope that in their current form they will not be a hindrance to excellence or innovation.

Sjogren’s syndrome in clinical trials of traditional Chinese medicine: protocol for the development of a core outcome set

Article

Full-text available

Mar 2021
TRIALS

Background Sjogren’s syndrome (SS) is a chronic autoimmune rheumatic disease with an incidence of 0.03 to 0.3%. In recent years, there are an increasing number of randomized controlled trials of traditional Chinese medicine (TCM) for SS. However, there are generally some problems in these published clinical trials: lack of reporting primary or long-term outcomes and the heterogeneous in different clinical trials’ outcome. Our study aims to determine the priority outcomes and standard TCM syndromes for all stakeholders and reach agreement on the COS and syndromes to be measured and reported in all future TCM trials in patients with SS. Methods and analysis A phase-wise refinement approach will be used, consisting of three phases, yet complementary, sub-work phases, whereby each phase will inform the next coming phases. The following are the three phases: (I-a) identifying of a long initial list of outcomes through systematic literature review and semi-structured qualitative interviews and (I-b) identifying an initial list of TCM syndromes through (1) systematic literature review, (2) referencing ancient Chinese medical books, and (3) retrospective studies of medical records; (II) prioritization of outcomes using Delphi survey with different stakeholders, such as health professionals and patients; and (III) through consensus meetings with patients and professionals to agree on the final COS and TCM syndromes. Discussion We summarized the actions of COS into three points: direct action, indirect action, and final action. After the final COSs is completed, we will publish this research in a journal to promote communication. Trial registration Core Outcome Measures in Effectiveness Trials Initiative (COMET) number 1429 . Registered on 01 December 2019.

Methodologies for network meta-analysis of randomised controlled trials in pain, anaesthesia, and perioperative medicine: a narrative review

Article

Feb 2025

Network meta-analysis has emerged as a method for analysing clinical trials, with a large increase in the number of publications over the past decade. Network meta-analysis offers advantages over traditional pairwise meta-analysis, including increased power, the ability to compare treatments not compared in the original trials, and the ability to rank treatments. However, network meta-analyses are inherently more complex than pairwise meta-analyses, requiring additional statistical expertise and assumptions. Many factors can affect the certainty of evidence from pairwise meta-analysis and can often lead to unreliable results. Network meta-analysis is prone to all these issues, although it has the additional assumption of transitivity. Here we review network meta-analyses, problems with their conduct and reporting, and methodological strategies that can be used by those conducting reviews to help improve the reliability of their findings. We provide evidence that violation of the assumption of transitivity is relatively common and inadequately considered in published network meta-analyses. We explain key concepts with clinically relevant examples for those unfamiliar with network meta-analysis to facilitate their appraisal and application of their results to clinical practice.

Reporting of Search Strategy Among Systematic Reviews in Leading Dental Specialty Journals: A Research-On-Research Study

Article

Nov 2024
J ORAL REHABIL

Background Literature searching is one of the main determinants of a systematic review (SR)'s reliability. Thus, adequate reporting of search strategy is essential for the critical appraisal of SRs and evidence‐based practice. Objectives To assess the reporting quality of search strategy among SRs in leading dental specialty journals, and to identify factors associated with quality of reporting. Materials and Methods Six leading dental journals with the highest 5‐year impact factors in their respective specialty were included. A hand search was undertaken to identify SRs published between 2017 and 2022. Full texts were reviewed by two authors to identify eligible SRs. Reporting quality was assessed and scored using a modified 15‐item checklist based on Preferred Reporting Items for Systematic reviews and Meta‐Analyses literature search extension (PRISMA‐S). Univariable and multivariable linear regression analyses were then performed. Settings and Sample population A total of 152 reviews were included and assessed. Results As for information sources, only ‘citation searching’ was adequately reported in most reviews 110 (72.4%). Only 23 (15.1%) of the included reviews clearly reported search strategies. Information about peer review was provided in only 10 reviews (6.6%). Only 91 (59.9%) of the included reviews documented the total records clearly. According to multivariable regression analysis, industrial funding ( p = 0.012), registration ( p = 0.013) and librarian involvement ( p = 0.004) were significantly associated with higher reporting quality. Conclusions The reporting quality of search strategy among SRs in leading dental specialty journals is suboptimal. Researchers, librarians, reviewers and journal editors in dentistry need to be familiar with the PRISMA‐S checklist, and make concerted efforts to improve the reporting of search strategy in SRs.

Improving peer review of systematic reviews and related review types by involving librarians and information specialists as methodological peer reviewers: a randomized controlled trial

Preprint

Sep 2024

Objective: To evaluate the impact of adding librarians and information specialists (LIS) as methodological peer reviewers to the formal journal peer review process on the quality of search reporting and risk of bias in systematic review searches in the medical literature.Methods: A pragmatic two-group parallel randomized controlled trial of systematic reviews and related evidence synthesis manuscripts submitted to The BMJ, BMJ Open, and BMJ Medicine and sent out for peer review from January 3, 2023 to September 1, 2023. Randomization (allocation ratio, 1:1) was stratified by journal and used permuted blocks (block size = 4). All manuscripts followed usual journal practice for peer review, but those in the intervention group had an additional (LIS) peer reviewer invited. The primary outcomes are the differences in first revision manuscripts between intervention and control groups in the quality of reporting and risk of bias. Quality of reporting was measured using four pre-specified PRISMA-S items. Risk of bias was measured using ROBIS Domain 2. Assessments were done in duplicate and assessors were blinded to group allocation. We performed intention to treat and per protocol analyses. As secondary outcomes, we analyzed differences between groups for each individual PRISMA-S and ROBIS Domain 2 item. We also assessed differences in the proportion of manuscripts rejected as the first decision between the intervention and control groups. The study protocol was registered (https://doi.org/10.17605/OSF.IO/W4CK2) and the protocol published (https://dx.doi.org/10.1186/s13063-021-05738-z).Results: Of 2,670 manuscripts sent to peer review during study enrollment, 400 met inclusion criteria and were randomized (62 The BMJ, 334 BMJ Open, 4 BMJ Medicine). By study close, 76 first revisions were submitted in the intervention group and 90 in the control group. Differences in the proportion of adequately reported searches (4.4% difference, 95% CI: -2.0%, 10.7%) and risk of bias in searches (0.5% difference, 95% CI: -13.7%, 14.6%) showed no statistically significant differences between groups. Inviting an LIS peer reviewer showed a difference (16.0%, 95% CI: 0.96%, 31.0%) on adequately reporting one individual item, PRISMA-S Item 13 (dates of search). By four months post-study, 98 intervention and 70 control group manuscripts had been rejected after peer review (13.8% difference, 95% CI: 3.9%, 23.8%). Conclusions: Inviting LIS peer reviewers did not impact adequate reporting or risk of bias of searches in first revision manuscripts of biomedical systematic reviews and related review types, though LIS peer reviewers may have contributed to a higher rate of rejection after peer review.

Efficacy and Safety of Tofacitinib on COVID-19 Patients: A Systematic Review and Meta-Analysis

Article

Sep 2024

The use of drugs off-label for managing COVID-19 offers a potential approach. Among these potential drugs, tofacitinib, a JAK inhibitor, is strongly implicated in its ability to mitigate mortality by attenuating the cytokine storm syndrome. This study systematically reviewed and quantitatively assessed the effectiveness and safety profile of tofacitinib use through meta-analysis. Through searches of the PubMed, Scopus, and the Cochrane Library databases up to May 31, 2024, six articles meeting inclusion criteria were identified, encompassing 669 patients diagnosed with COVID-19. The review findings indicate that tofacitinib use demonstrates significant clinical efficacy, as evidenced by a reduced risk of mortality (P = 0.003), and a decreased need for invasive mechanical ventilation (P = 0.0002). Furthermore, tofacitinib use is not correlated with an increased risk of adverse drug reactions (P = 0.98), indicating a favorable safety profile. In conclusion, the evidence supports the clinical efficacy of tofacitinib for COVID-19 patients without concomitant risks of adverse effects. Further clinical studies, especially larger-scale randomized controlled trials, are necessary to validate the findings of this study.

Search Methods for Systematic Reviews and Bibliographic Articles Can Improve: Responsibilities of Authorship Are Vast

Article

Jun 2023
ARTHROSCOPY

Certain types of scientific articles, including bibliographic articles, systematic reviews, and meta-analyses, require systematic search of electronic databases. Literature must be searched using clearly specified search terms, dates, and algorithms; article inclusion and exclusion criteria; and explicitly named databases. Search methods must be described in detail to allow reproducibility. In addition, responsibilities of all authors include contributing to study conception, design, data acquisition, analysis or interpretation; drafting or critically revising the work; approving the final version to be published; being accountable for the accuracy and integrity; being available to respond to queries including after publication; being able to identify which co-authors are responsible for which parts; and maintaining primary data and underpinning analysis for at least 10 years. The responsibilities of authorship are vast.

An Overview of Systematic Reviews and Meta-Analyses of Acupuncture Treatment of Chronic Prostatitis

Article

Jan 2022

Who's Publishing Systematic Reviews? An Examination Beyond the Health Sciences

Article

Full-text available

Dec 2022

The number of systematic reviews (SRs) published continues to grow, and the methodology of evidence synthesis has been adopted in many fields outside of its traditional health sciences origins. SRs are now published in fields as wide ranging as business, environmental science, education, and engineering; however, there is little research looking at the nature and prevalence of non-health sciences systematic reviews (non-HSSRs). In this study, a large sample from the Scopus database was used as the basis for analyzing SRs published outside the health sciences. To map the current state of non-HSSRs, their characteristics were investigated and the subject areas publishing them determined. The results showed that a majority of the non-HSSRs examined were lacking at least one characteristic commonly expected in health sciences systematic review (HSSRs) methodology. The broad subject areas publishing non-HSSRs fall mostly within the social sciences and physical sciences.

Reporting and methodological quality of acupuncture network meta-analyses could be improved: an evidence mapping

Article

Nov 2022
J CLIN EPIDEMIOL

Objective To evaluate and map the reporting and methodological quality of network meta-analysis (NMA) on acupuncture. Study Design and Setting Published acupuncture NMAs were searched through eight databases from inception to Feb 2022. The reporting and methodological quality of included studies was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analysis (PRISMA-NMA) statement and the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) checklist. Results A total of 113 NMAs were identified. Most (99, 87.61%) studies were performed in China. Most studies focused on multiple acupuncture techniques (82.30%), and the main studied ailments were pain and post-stroke sequelae (20.24%). The median (interquartile range (IQR)) score of the reporting quality was 26.5 (25-28.5). However, poor reporting rates in the protocol and registration (33.63%) and geometry of the network (35.40%), especially for China-based studies, were identified. The methodological quality of only 2 (1.77%) English studies was high. The reporting rate of Chinese studies was below 15% on each of items 4, 7, 10, and 12. Conclusion The reporting quality of the NMAs was moderate, but the methodological quality was very low. The reporting and methodological quality of future NMAs, especially for Chinese studies, need further improvement.

CARDA: Guiding document analyses in health professions education research

Article

Oct 2022
MED EDUC

Introduction: Documents, from policies and procedures to curriculum maps and examination papers, structure the everyday experiences of health professions education (HPE), and as such can provide a wealth of empirical information. Document analysis (DA) is an umbrella term for a range of systematic research procedures that use documents as data. Methods: A meta-study review was conducted with the aims of describing the current state of DA in HPE, guiding researchers engaging in DA, and improving methodological, analytical, and reporting rigour. Structured searches were conducted, returns were filtered for inclusion, and the 115 remaining articles were critically analyzed for their use of DA methods and methodologies. Results: There was a significant increase in the number of articles reporting the use of DA over time. Sixty-three articles were single method (DA only), while the others were mixed-methods research (MMR). Overall, there were major lacuna in terms of why documents were used, how documents were identified, what the authors did and what they found from the documents. This was particularly apparent in MMR where DA reporting was typically poorer than the reporting of other methods in the same paper. Discussion: Given these many lacunae, a framework for reporting on DA research was developed to facilitate rigorous DA research and transparent, complete and accurate reporting of the same, to help readers assess the trustworthiness of the findings from document use and analysis in HPE and, potentially, other domains. It was also noted that there are gaps in HPE knowledge that could be addressed through DA, particularly where documents are conceptualized as more than passive holders of information. Scholars are encouraged to reflect more deeply on the applications and practices of DA, with the ultimate aim of ensuring more substantive and more rigorous use of documents for understanding and constructing meaning in our field.

Identifying Randomized Controlled Trials

Chapter

Apr 2022

In 1993, before the establishment of Cochrane (formerly the Cochrane Collaboration), only 19 000 reports of randomized controlled trials were readily identifiable (i.e. indexed as such) in MEDLINE, though there were many more within the database. In 1996, the Cochrane Central Register of Controlled Trials (CENTRAL) was launched, in the Cochrane Library, and now contains nearly 2 million records or reports of trials from MEDLINE, Embase, ClinicalTrials.gov , and other sources. In addition to CENTRAL, other sources should be searched to try to minimize publication bias, such as national, international, and regional databases; subject‐specific databases; trials registers, regulatory agency sources, and sources of clinical study reports; and sources specific to systematic reviews. A number of recent initiatives have contributed to greater transparency in trial registration and reporting, but much remains to be done. Highly sensitive, but adequately precise, searches of appropriate sources are fundamental to the process of conducting reliable, trustworthy systematic reviews.

Can Therapeutic Exercises Improve Proprioception in Chronic Ankle Instability? A Systematic Review and Network Meta-analysis

Article

May 2022
ARCH PHYS MED REHAB

Objective To assess exercise therapies that aim to enhance proprioception in individuals with chronic ankle instability (CAI). Data Sources Five databases (PubMed, Embase, Cochrane Library, Web of Science, and EBSCO) were searched in October 2021. Study Selection Randomized controlled trials involving exercise therapy conducted on individuals with CAI were included. Data Extraction Data were extracted by two independent reviewers using a standardized form. Methodological quality and risk of bias were assessed with the PEDro scale. Data Synthesis The end-trial weighted mean difference and standard deviations were analyzed, and the synthetic value for the improvement in error scores of ankle joint position sense (JPS) in multiple directions was evaluated. Results Eleven trials with 333 participants were eligible for inclusion in this systematic review and were included in the Network Meta-Analysis. Foot and ankle muscle strengthening exercise showed the highest probability of being among the best treatments (surface under the cumulative ranking (SUCRA)=74.6%). The next two were static balance exercise only (SUCRA=67.9%) and corrective exercise (SUCRA=56.1%). The SUCRA values of proprioceptive exercise, dynamic balance exercise only, aquatic exercise, rehabilitation exercise with brace, mixed static/dynamic balance exercise, and control were at relatively low levels, and scored at 49.6%, 48.8%, 47.8%, 47.7%, 44.0%, and 13.5%, respectively. Conclusions Foot and ankle muscle strengthening exercise may have a good effect when used to improve JPS in individuals with CAI. Probably, the more complex balance exercise intervention becomes, the less effective the proprioceptive outcome. PROSPERO registration number CRD42021240331. 50 day full-text access courtesy of publisher: https://protect-au.mimecast.com/s/PGfiC1WZg1fkjl76ipIcCR?domain=authors.elsevier.com

The Methodological and Reporting Quality of Acupuncture Network Meta-Analysis: An Evidence Mapping

Article

Jan 2022

The Effect of Varenicline and Bupropion on Smoking Cessation: a Network Meta-Analysis of 20 Randomized Controlled Trials

Article

Apr 2022
ADDICT BEHAV

Objective A network meta-analysis (NMA) was conducted to investigate the effect of varenicline (VAR), bupropion (BUP), and nicotine replacement therapy (NRT) on smoking cessation. Methods Eight databases were searched in May 2021, and only randomized controlled trials (RCTs) using varenicline, bupropion, or NRT (single or combined) for smoking cessation were included. The risk of bias in the included RCTs was assessed using the Cochrane Handbook tool. Stata 15.1 software was used to perform NMA, and the quality of the evidence was evaluated using Confidence in Network Meta-analysis (CINeMA). Findings: Twenty RCTs involving 16,702 smokers were included. The risk of bias results showed that 10 RCTs were rated as high, three were low, and seven were unclear. A total of 21 pairs were compared based on seven interventions. The NMA showed that, compared to the placebo (PLA), the other six interventions had significant efficacy in smoking cessation, where VAR+BUP showed the best effect of all treatments (odds ratio (OR) = 6.08, 95% confidence interval (CI) [3.47, 10.66]). Moreover, VAR+BUP was superior to VAR+NRT (OR = 1.66, 95% CI [1.07, 2.59]) and the three monotherapies (VAR, BUP, and NRT). In the monotherapies, the results of pairwise comparisons of VAR, BUP, and NRT did not show significant differences. Finally, the surface under the cumulative ranking curve (SUCRA) value indicated that VAR+BUP had the greatest probability of becoming the best intervention. Conclusions The efficacy of VAR, BUP, and NRT alone increased the odds of smoking abstinence better than the placebo, combined interventions were superior to monotherapy, and VAR combined with other interventions had a better smoking cessation effect.

Bibliometric Analysis and Systematic Review of Global Coronavirus Research Trends Before COVID-19: Prospects and Implications for COVID-19 Research

Article

Full-text available

Nov 2021

Coronaviruses (CoV) cause respiratory and intestinal infections. We conducted this bibliometric analysis and systematical review to explore the CoV-related research trends from before COVID-19. We systematically searched the Ovid MEDLINE, Ovid Embase, and Web of Science (WOS) databases for published bibliometric analyses of CoV from database inception to January 24, 2021. The WOS Collection was searched from inception to January 31, 2020, to acquire the CoV-related publications before COVID-19. One-Way ANOVA and Bonferroni multiple-comparison tests were used to compare differences. Visualization mapping and keyword cluster graphs were made to illustrate the research topics and hotpots. We included 14,141 CoV-related publications for the bibliometric analysis and 16 (12 articles) CoV-related bibliometric analyses for the systematic review. Both the systematic review and bibliometric analysis showed (1) the number of publications showed two steep upward trajectories in 2003–2004 and in 2012–2014; (2) the research hotpots mainly focused on the mechanism, pathology, epidemiology, clinical diagnosis, and treatment of the coronavirus in MERS-CoV and SARS-Cov; (3) the USA, and China; the University of Hong Kong; and Yuen KY, came from the University of Hong Kong contributed most; (4) the Journal of Virology had the largest number of CoV related studies. More studies should focus on prevention, diagnosis, and treatment in the future.

The efficacy and safety of intermittent preventive treatment with sulphadoxine-pyrimethamine vs artemisinin-based drugs for malaria: a systematic review and meta-analysis

Article

Oct 2021

Background Malaria is one of the most serious global problems. The objective of this study is to assess whether intermittent preventive treatment (IPT) using artemisinin-based combination therapies (ACTs) was a promising alternative to IPT with sulphadoxine-pyrimethamine (IPT-SP). Methods We searched the following sources up to 12 August 2020: PubMed, The Cochrane Library, Embase, Web of Science, CNKI, CBM, VIP and WanFang Database from inception. The randomized controlled trials comparing SP with ACTs for malaria were included. Data were pooled using Stata.14 software. We performed subgroup analysis based on the different types of ACTs groups and participants. Results A total of 13 studies comprising 5180 people were included. The meta-analysis showed that ACTs had the lower risk of number of any parasitemia (RR=0.46; 95% CI 0.22 to 0.96, p=0.039; I2=90.50%, p<0.001), early treatment failure (RR=0.17; 95% CI 0.06 to 0.48, p<0.001; I2=66.60%, p=0.011) and late treatment failure (RR=0.34; 95% CI 0.13 to 0.92, p<0.001; I2=87.80%, p<0.001) compared with SP. There was no significant difference in adequate clinical response, average hemoglobin and adverse neonatal outcomes. Conclusion Combinations with ACTs appear promising as suitable alternatives for IPT-SP.

Comparative efficacies of different immunotherapy regimens in recurrent implantation failure: A systematic review and network meta-analysis

Article

Sep 2021
J REPROD IMMUNOL

For patients with recurrent implantation failure (RIF), immune system imbalances have become the focus of research. The effects of different classes of immunotherapies on improving pregnancy outcomes have not been fully established. This network meta-analysis was performed to assess the impact of popular immunotherapies in women with RIF. We systematically searched the Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of Science databases as well as clinical trial registration websites. Randomized controlled trials comparing immunotherapeutic outcomes were included. We performed the random-effects network meta-analysis to compare efficacy measures. A total of 21 trials involving 2277 participants and 8 immunotherapies were eligible for this study. Patients that had been administered with PBMCs, G-CSF, PRP, and sirolimus exhibited higher CPR than those administered with the placebo (2.63, 1.71 to 4.06; 2.03, 1.35 to 3.05; 1.98, 1.02 to 3.84; 2.55, 1.36 to 4.79; and 3.95, 1.33 to 11.72, respectively). For IR, only PBMCs and G-CSF were significantly more effective than the placebo (2.92, 1.39 to 6.12; 2.66, 1.16 to 6.06, respectively). In terms of LBR, PBMCs (2.96, 1.67 to 5.27) and sirolimus (3.55, 1.18 to 10.64) were effective. However, r-hLIF (0.25, 0.10 to 0.62) had a reduced risk of LBR. No therapeutic regimen was found to have significantly decreased MR, but PBMCs exhibited the lowest rank among all interventions (0.28, 0.06 to 1.44). To improve clinical pregnancy while reducing miscarriage outcomes, PBMCs might be a beneficent therapeutic option for RIF in the future

Which Is the Optimal Method of Early Rehabilitation in Mechanically Ventilated Patients: a Protocol for Network Meta-analysis

Preprint

Full-text available

Aug 2021

Introduction Early rehabilitation of mechanically ventilated patients is safe, feasible and beneficial to prevent ICU-AW and its consequences. However, there are no guidelines or evidence-based studies about the optimal protocol of early rehabilitation. There is traditional meta-analysis about the effect of simple protocol, such as active mobilization, neuromuscular electrical stimulation, in-bed cycling exercise, interactive video games and so on, but no studies to explore the effects of multiple protocols together. For the extensive clinical implementation, it is important to conduct a network meta-analysis to compare the effect of different protocols of early rehabilitation. Methods and analysis PubMed, Cochrane library, Web of Science, EMbase, grey literature and referent literature will be searched from inception to August 2019. Study selection, data extraction and quality assessment will be performed independently by two reviewers. The primary outcome is ICU acquired weakness (ICU-AW), secondary outcomes include the duration of mechanical ventilation and length of stay in ICU and hospital. Statistical analysis and graphical presentations will be conducted by R software (V.3.6.0). Cochrane Handbook for Systematic Reviews (V5.1.0) will be used to conduct the quality assessment. The rank possibility will be performed by the histogram. Statistical inconsistency assessment, sensitivity analysis and publication bias will be performed. Discussion This protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. The protocol gives an insight into the scope and parameters for the systematic review to be carried out. Registration number PROSPERO CRD42020141901

Systematic reviews: Structure, form and content

Article

Full-text available

Jul 2021
J Perioperat Pract

This article aims to provide an overview of the structure, form and content of systematic reviews. It focuses in particular on the literature searching component, and covers systematic database searching techniques, searching for grey literature and the importance of librarian involvement in the search. It also covers systematic review reporting standards such as PRISMA-P and PRISMA, critical appraisal and tools and resources to support the review and ensure it is conducted efficiently and effectively. Finally, it summarizes the requirements when screening search results for inclusion in the review, and the statistical synthesis of included studies' findings.

The efficacy and safety of JAK Inhibitors for Atopic Dermatitis: a systematic review and meta-analysis

Article

Jun 2021

Background Atopic dermatitis (AD) is one of the serious global problems. There were wide concerns about whether Janus kinase (JAK) inhibitor was an alternative treatment for AD. Method Eight databases were searched from the earliest publication date available to January 2, 2021. We included randomized controlled trials comparing JAK inhibitors with control treatment for AD. Data were pooled using Stata.14 software and performed as mean differences (MD) and risk ratios (RR) with 95% CIs. We did subgroup analysis based on specific outcomes. Results A total of studies, ten randomized controlled trials, with 2583 patients were included in the final synthesis. This meta-analysis showed JAK inhibitor resulted in significant improvement on EASI total score (MD = -0.31; 95%CI, -0.46–-0.17; P = 0.000; I² = 90.0%, P = 0.000) and pruritus numerical rating scale (NRS) score (MD = -1.15; 95%CI, -1.48–-0.83; P = 0.000; I² = 95.9%, P = 0.000), without the higher risk of total adverse effects (RR =1.02; 95%CI, 0.90–1.16; P = 0.745; I² =27.9%, P = 0.206). Conclusions JAK inhibitor was a promising option for atopic dermatitis. More data and surveillance will be needed to identify efficacy, safety, and the risk of adverse effects.

Impact of the Duration of Breastfeeding on the Intelligence of Children: A Systematic Review with Network Meta-Analysis

Article

Jun 2021

Objective: To evaluate the impact of the duration of breastfeeding on the intelligence of children. Materials and Methods: Eight electronic databases were searched to identify studies that investigated the impact of breastfeeding on the intelligence of children. Data were pooled, and the ratio of means (RoM) and the corresponding 95% confidence interval (95% CI) were calculated using a pairwise meta-analysis and network meta-analysis. Risk of bias was assessed using a tool developed by the CLARITY group. Data were analyzed using R version 3.5.1. Results: A total of 16 studies with 9,162 subjects were included in the review. Half of the studies were at low risk of bias. A meta-analysis indicated that breastfed children had a score 1.04-fold higher in intelligence tests compared with those that had never been breastfed (RoM: 1.04, 95% CI: 1.02-1.06, p < 0.05). Evidence from a network meta-analysis indicated that breastfeeding for ≤6 months resulted in score 1.04-fold higher in intelligence tests (RoM: 1.04, 95% CI: 1.03-1.06, p < 0.05) and children breastfed for >6 months had a score 1.06-fold higher (RoM: 1.06, 95% CI: 1.05-1.08, p < 0.05) than children that had never been breastfed. Thus, breastfeeding for >6 months demonstrated a slightly higher score than breastfeeding for ≤6 months (RoM: 1.02, 95% CI: 1.00-1.04, p < 0.05). Conclusion: Breastfeeding could significantly improve the intelligence of children, with a duration of >6 months showing a slight but significantly higher intelligence score than for ≤6 months.

Identification of robust diagnostic and prognostic gene signatures in different grades of gliomas: a retrospective study

Article

Full-text available

May 2021

Background Gliomas are the most common primary tumors of the central nervous system. The complexity and heterogeneity of the tumor makes it difficult to obtain good biomarkers for drug development. In this study, through The Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA), we analyze the common diagnostic and prognostic moleculer markers in Caucasian and Asian populations, which can be used as drug targets in the future. Methods The RNA-seq data from Genotype-Tissue Expression (GTEx) and The Cancer Genome Atlas (TCGA) were analyzed to identify signatures. Based on the signatures, the prognosis index (PI) of every patient was constructed to predict the prognostic risk. Also, gene ontology (GO) functional enrichment analysis and KEGG analysis were conducted to investigate the biological functions of these mRNAs. Glioma patients’ data in the CGGA database were introduced to validate the effectiveness of the signatures among Chinese populations. Excluding the previously reported prognostic markers of gliomas from this study, the expression of HSPA5 and MTPN were examined by qRT-PCR and immunohistochemical assay. Results In total, 20 mRNAs were finally selected to build PI for patients from TCGA, including 16 high-risk genes and four low-risk genes. For Chinese patients, the log-rank test p values of PI were both less than 0.0001 in two independent datasets. And the AUCs were 0.831 and 0.907 for 3 years of two datasets, respectively. Moreover, among these 20 mRNAs, 10 and 15 mRNAs also had a significant predictive effect via univariate COX analysis in CGGA_693 and CGGA_325, respectively. qRT-PCR and Immunohistochemistry assay indicated that HSPA5 and MTPN over-expressed in Glioma samples compared to normal samples. Conclusion The 20-gene signature can forecast the risk of Glioma in TCGA effectively, moreover it can also predict the risks of Chinese patients through validation in the CGGA database. HSPA5 and MTPN are possible biomarkers of gliomas suitable for all populations to improve the prognosis of these patients.

A bibliometric analysis of global research output on network meta-analysis

Article

Full-text available

May 2021
BMC MED INFORM DECIS

Background Network meta-analysis (NMA) has been widely used in the field of medicine and health, but the research topics and development trends are still unclear. This study aimed to identify the cooperation of countries and institutes and explore the hot topics and future prospects in the field of NMA. Methods Data of publications were downloaded from the Web of Science Core Collection. We used CiteSpace V, HistCite 2.1, and Excel 2016 to analyze literature information, including years, journals, countries, institutes, authors, keywords, and co-cited references. Results NMA research developed gradually before 2010 and rapidly in the following years. 2846 NMA studies were published in 771 journals in six languages. The PLoS One (110, 3.9%) was the most productive journal, and N Engl J Med (5904 co-citations) was the most co-cited journal. The most productive country was the United States (889, 31%) and the most productive institute was the University of Bristol (113, 4.0%). The active collaborations were observed between developed countries and between productive institutes. Of the top 10 authors, four were from the UK, and among the top 10 co-cited authors, six were from the UK. Randomized evidence, oral anti-diabetic drugs, coronary artery bypass, certolizumab pegol, non-valvular atrial fibrillation, and second-line antihyperglycemic therapy were the hot topics in this field. Conclusions NMA studies have significantly increased over the past decade, especially from 2015 to 2017. Compared with developing countries, developed countries have contributed more to these publications and have closer cooperation, indicating that cooperation between developed and developing countries should be further strengthened. The treatment of diabetes, cardiovascular diseases, and immune rheumatism are the main hot topics.

Adoption of peer review of literature search strategies in knowledge synthesis from 2009 to 2018: An overview

Article

Mar 2021

Christine J Neilson

Background Knowledge synthesis (KS) reviews rely on good quality literature searches to capture a complete set of relevant studies, and peer review of the search strategy is one quality control mechanism that contributes to better quality reviews. Guidelines for peer review of electronic search strategies (PRESS) have been available since 2008. Objectives This overview provides a snapshot of KS indexed in Scopus, published between 2009 and 2018, that reported peer review of the literature search strategy. Methods Articles were identified through citation chasing for PRESS guidance documents and supplementary keyword searches. The characteristics of individual articles and the journals that published them were documented, and descriptive statistics were compiled. Results 415 articles from 169 journals met inclusion criteria. Approximately half were published in 14 journal titles. Most reviews reported the involvement of an information professional, but PRESS reviewers were rarely acknowledged. An overwhelming majority of review teams were based in Canada. Discussion Reported use of PRESS was low during the period examined, but under‐reporting may be a factor. Investigation of the barriers and facilitators of PRESS adoption is needed. Conclusion Despite its value, adoption of PRESS appears low. Advocacy for, and education about, PRESS may be required.

Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers

Article

Full-text available

Jul 2013
BMC MED

In the last decade, network meta-analysis of randomized controlled trials has been introduced as an extension of pairwise meta-analysis. The advantage of network meta-analysis over standard pairwise meta-analysis is that it facilitates indirect comparisons of multiple interventions that have not been studied in a head-to-head fashion. Although assumptions underlying pairwise meta-analyses are well understood, those concerning network meta-analyses are perceived to be more complex and prone to misinterpretation. In this paper, we aim to provide a basic explanation when network meta-analysis is as valid as pairwise meta-analysis. We focus on the primary role of effect modifiers, which are study and patient characteristics associated with treatment effects. Because network meta-analysis includes different trials comparing different interventions, the distribution of effect modifiers cannot only vary across studies for a particular comparison (as with standard pairwise meta-analysis, causing heterogeneity), but also between comparisons (causing inconsistency). If there is an imbalance in the distribution of effect modifiers between different types of direct comparisons, the related indirect comparisons will be biased. If it can be assumed that this is not the case, network meta-analysis is as valid as pairwise meta-analysis. The validity of network meta-analysis is based on the underlying assumption that there is no imbalance in the distribution of effect modifiers across the different types of direct treatment comparisons, regardless of the structure of the evidence network.

Analysis of the systematic reviews process in reports of network meta-analyses: Methodological systematic review

Article

Full-text available

Jul 2013
Br Med J

To examine whether network meta-analyses, increasingly used to assess comparative effectiveness of healthcare interventions, follow the key methodological recommendations for reporting and conduct of systematic reviews. Methodological systematic review of reports of network meta-analyses. Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Medline, and Embase, searched from inception to 12 July 2012. All network meta-analyses comparing clinical efficacy of three or more interventions based on randomised controlled trials, excluding meta-analyses with an open loop network of three interventions. We assessed the reporting of general characteristics and key methodological components of the systematic review process using two composite outcomes. For some components, if reporting was adequate, we assessed their conduct quality. Of 121 network meta-analyses covering a wide range of medical areas, 100 (83%) assessed pharmacological interventions and 11 (9%) non-pharmacological interventions; 56 (46%) were published in journals with a high impact factor. The electronic search strategy for each database was not reported in 88 (73%) network meta-analyses; for 36 (30%), the primary outcome was not clearly identified. Overall, 61 (50%) network meta-analyses did not report any information regarding the assessment of risk of bias of individual studies, and 103 (85%) did not report any methods to assess the likelihood of publication bias. Overall, 87 (72%) network meta-analyses did not report the literature search, searched only one database, did not search other sources, or did not report an assessment of risk of bias of individual studies. These methodological components did not differ by publication in a general or specialty journal or by public or private funding. Essential methodological components of the systematic review process-conducting a literature search and assessing risk of bias of individual studies-are frequently lacking in reports of network meta-analyses, even when published in journals with high impact factors.

Searching for unpublished data for Cochrane reviews: cross sectional study

Article

Full-text available

Apr 2013

Objective To describe the experiences of authors of Cochrane reviews in searching for, getting access to, and using unpublished data. Design Cross sectional study. Setting Cochrane reviews. Participants 2184 corresponding authors of Cochrane reviews as of May 2012. Main outcome measure Frequencies of responses to open ended and closed questions in an online survey. Results Of 5915 authors contacted by email, 2184 replied (36.9% response rate). Of those, 1656 (75.8%) had searched for unpublished data. In 913 cases (55.1% of 1656), new data were obtained and we received details about these data for 794 data sources. The most common data source was “trialists/investigators,” accounting for 73.9% (n=587) of the 794 data sources. Most of the data were used in the review (82.0%, 651/794) and in 53.4% (424/794) of cases data were provided in less than a month. Summary data were most common, provided by 50.8% (403/794) of the data sources, whereas 20.5% (163/794) provided individual patient data. In only 6.3% (50/794) of cases were data reported to have been obtained from the manufacturers, and this group waited longer and had to make more contacts to get the data. The data from manufacturers were less likely to be for individual patients and less likely to be used in the review. Data from regulatory agencies accounted for 3.0% (24/794) of the obtained data. Conclusions Most authors of Cochrane reviews who searched for unpublished data received useful information, primarily from trialists. Our response rate was low and the authors who did not respond were probably less likely to have searched for unpublished data. Manufacturers and regulatory agencies were uncommon sources of unpublished data.

Network meta-analysis-highly attractive but more methodological research is needed

Article

Full-text available

Jun 2011
BMC MED

Network meta-analysis, in the context of a systematic review, is a meta-analysis in which multiple treatments (that is, three or more) are being compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator. To ensure validity of findings from network meta-analyses, the systematic review must be designed rigorously and conducted carefully. Aspects of designing and conducting a systematic review for network meta-analysis include defining the review question, specifying eligibility criteria, searching for and selecting studies, assessing risk of bias and quality of evidence, conducting a network meta-analysis, interpreting and reporting findings. This commentary summarizes the methodologic challenges and research opportunities for network meta-analysis relevant to each aspect of the systematic review process based on discussions at a network meta-analysis methodology meeting we hosted in May 2010 at the Johns Hopkins Bloomberg School of Public Health. Since this commentary reflects the discussion at that meeting, it is not intended to provide an overview of the field.

An evidence-based guideline for the peer review of electronic search strategies

Article

Full-text available

Mar 2009

Complex and highly sensitive electronic literature search strategies are required for systematic reviews; however, no guidelines exist for their peer review. Poor searches may fail to identify existing evidence because of inadequate recall (sensitivity) or increase the resource requirements of reviews as a result of inadequate precision. Our objective was to create an annotated checklist for electronic search strategy peer review. A systematic review of the library and information retrieval literature for important elements in electronic search strategies was conducted, along with a survey of individuals experienced in systematic review searching. Six elements with a strong consensus as to their importance in peer review were accurate translation of the research question into search concepts, correct choice of Boolean operators and of line numbers, adequate translation of the search strategy for each database, inclusion of relevant subject headings, and absence of spelling errors. Seven additional elements had partial support and are included in this guideline. This evidence-based guideline facilitates the improvement of search quality through peer review, and thus the improvement in quality of systematic reviews. It is relevant for librarians/information specialists, journal editors, developers of knowledge translation tools, research organizations, and funding bodies.

Analysis of the reporting of search strategies in Cochrane Systematic Reviews

Article

Full-text available

Feb 2009
J MED LIBR ASSOC

The Cochrane Handbook for Systematic Reviews of Interventions provides instructions for documenting a systematic review's electronic database search strategy, listing elements that should be in the description. Complete documentation of the search strategy allows readers to evaluate the search when critically appraising a review's quality. The research analyzed recently published Cochrane reviews to determine whether instructions for describing electronic database search strategies were being followed. Eighty-three new reviews added to the Cochrane Database of Systematic Reviews in the first quarter of 2006 were selected for analysis. Eighteen were subsequently excluded because their searches were conducted only in the specialized registers of Cochrane review groups. The remaining sixty-five reviews were analyzed for the seven elements of an electronic database search strategy description listed in the Cochrane Handbook, using dual review with consensus. Of the 65 reviews analyzed, none included all 7 recommended elements. Four reviews (6%) included 6 elements. Thirty-two percent (21/65) included 5 or more elements, with 68% (44/65) including 4 or fewer. Three included only 2 elements. The 65 reviews represented 41 different Cochrane review groups. The instructions from the Cochrane Handbook for reporting search strategies are not being consistently employed by groups producing Cochrane reviews.

Which resources should be used to identify RCT/CCTs for systematic reviews: A systematic review

Article

Full-text available

Feb 2005
BMC MED RES METHODOL

Systematic reviewers seek to comprehensively search for relevant studies and summarize these to present the most valid estimate of intervention effectiveness. The more resources searched, the higher the yield, and thus time and costs required to conduct a systematic review. While there is an abundance of evidence to suggest how extensive a search for randomized controlled trials (RCTs) should be, it is neither conclusive nor consistent. This systematic review was conducted in order to assess the value of different resources to identify trials for inclusion in systematic reviews. Seven electronic databases, four journals and Cochrane Colloquia were searched. Key authors were contacted and references of relevant articles screened. Included studies compared two or more sources to find RCTs or controlled clinical trials (CCTs). A checklist was developed and applied to assess quality of reporting. Data were extracted by one reviewer and checked by a second. Medians and ranges for precision and recall were calculated; results were grouped by comparison. Meta-analysis was not performed due to large heterogeneity. Subgroup analyses were conducted for: search strategy (Cochrane, Simple, Complex, Index), expertise of the searcher (Cochrane, librarian, non-librarian), and study design (RCT and CCT). Sixty-four studies representing 13 electronic databases met inclusion criteria. The most common comparisons were MEDLINE vs. handsearching (n = 23), MEDLINE vs. MEDLINE+handsearching (n = 13), and MEDLINE vs. reference standard (n = 13). Quality was low, particularly for the reporting of study selection methodology. Overall, recall and precision varied substantially by comparison and ranged from 0 to 100% and 0 to 99%, respectively. The trial registries performed the best with median recall of 89% (range 84, 95) and median precision of 96.5% (96, 97), although these results are based on a small number of studies. Inadequate or inappropriate indexing was the reason most cited for missing studies. Complex and Cochrane search strategies (SS) performed better than Simple SS. Multiple-source comprehensive searches are necessary to identify all RCTs for a systematic review, although indexing needs to be improved. Although trial registries demonstrated the highest recall and precision, the Cochrane SS or a Complex SS in consultation with a librarian are recommended. Continued efforts to develop CENTRAL should be supported.

Evaluation of networks of randomized trials

Article

Full-text available

Jul 2008
STAT METHODS MED RES

Randomized trials may be designed and interpreted as single experiments or they may be seen in the context of other similar or relevant evidence. The amount and complexity of available randomized evidence vary for different topics. Systematic reviews may be useful in identifying gaps in the existing randomized evidence, pointing to discrepancies between trials, and planning future trials. A new, promising, but also very much debated extension of systematic reviews, mixed treatment comparison (MTC) meta-analysis, has become increasingly popular recently. MTC meta-analysis may have value in interpreting the available randomized evidence from networks of trials and can rank many different treatments, going beyond focusing on simple pairwise-comparisons. Nevertheless, the evaluation of networks also presents special challenges and caveats. In this article, we review the statistical methodology for MTC meta-analysis. We discuss the concept of inconsistency and methods that have been proposed to evaluate it as well as the methodological gaps that remain. We introduce the concepts of network geometry and asymmetry, and propose metrics for the evaluation of the asymmetry. Finally, we discuss the implications of inconsistency, network geometry and asymmetry in informing the planning of future trials.

Conceptual and technical challenges in network meta-analysis

Article

Jan 2008

Biofuels in Brazil

Chapter

Feb 2013

Roland A. Jansen

Introduction: Biofuel Industry Leader Comparison with the United States What is Driving the Urgency in Renewable Jet Fuel? Biofuels from Sugarcane Sugar Production Ethanol Production and Flex-Fuel Cars Bagasse, Bioelectricity, and Biofuels Flex-Fuel=Biofuel Fuel Consumption Greenhouse Gas Reductions Energy Balance Sugarcane for Biofuels Sugarcane Straw: A Growth Opportunity Bioplastics Biofuels and Public Health Cautionary Notes The Bottom Line

Cochrane Handbook for Systematic Reviews of Interventions

Book

Jan 2011

Conceptual and Technical Challenges in Network Meta-analysis

Article

Jul 2013
ANN INTERN MED

The increase in treatment options creates an urgent need for comparative effectiveness research. Randomized, controlled trials comparing several treatments are usually not feasible, so other methodological approaches are needed. Meta-analyses provide summary estimates of treatment effects by combining data from many studies. However, an important drawback is that standard meta-analyses can compare only 2 interventions at a time. A new meta-analytic technique, called network meta-analysis (or multiple treatments meta-analysis or mixed-treatment comparison), allows assessment of the relative effectiveness of several interventions, synthesizing evidence across a network of randomized trials. Despite the growing prevalence and influence of network meta-analysis in many fields of medicine, several issues need to be addressed when constructing one to avoid conclusions that are inaccurate, invalid, or not clearly justified. This article explores the scope and limitations of network meta-analysis and offers advice on dealing with heterogeneity, inconsistency, and potential sources of bias in the available evidence to increase awareness among physicians about some of the challenges in interpretation.

Mixed treatment comparisons: Combination of direct and indirect evidence. Statistics in Medicine 2004, 23:3105-3124

Article

Oct 2004

Mixed treatment comparison (MTC) meta-analysis is a generalization of standard pairwise meta-analysis for A vs B trials, to data structures that include, for example, A vs B, B vs C, and A vs C trials. There are two roles for MTC: one is to strengthen inference concerning the relative efficacy of two treatments, by including both 'direct' and 'indirect' comparisons. The other is to facilitate simultaneous inference regarding all treatments, in order for example to select the best treatment. In this paper, we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS. These are multivariate random effects models that allow for variation in true treatment effects across trials. We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models. We also compare models with fixed (unconstrained) baseline study effects with models with random baselines drawn from a common distribution. These models are applied to an illustrative data set and posterior parameter distributions are compared. We discuss model critique and model selection, illustrating the role of Bayesian deviance analysis, and node-based model criticism. The assumptions underlying the MTC models and their parameterization are also discussed.

Should meta-analysts search EMBASE in addition to Medline?

Article

Oct 2003
J CLIN EPIDEMIOL

It is widely accepted that meta-analysts should search multiple databases. The selection of databases is ideally based on the potential contribution of each database to the project or on the potential for bias if a database is excluded, as supported by research evidence. We explore whether searching Embase yields additional trials that influence a meta-analysis. We identified meta-analyses that searched Medline and Embase. A random-effects weighted mean method was used to estimate the intervention effect in articles indexed only in Embase compared with those indexed elsewhere. On average, Embase-unique trials yielded significantly smaller estimates by 29% (ratio of odds ratio [ROR] 0.71, 95% confidence interval [CI] 0.56-0.90) but influenced the pooled estimate by an average of only 6% (ROR 0.94, 95% CI 0.88-0.99). Searching Medline but not Embase risks biasing a meta-analysis by finding studies that show larger estimates, but their prevalence seems low enough that the risk may be slight, provided the rest of the search is comprehensive.

Directed acyclic graphs can help understand bias in indirect and mixed treatment comparisons

Article

Apr 2012

To introduce and advocate directed acyclic graphs (DAGs) as a useful tool to understand when indirect and mixed treatment comparisons are invalid and guide strategies that limit bias. By means of DAGs, it is heuristically explained when indirect and mixed treatment comparisons are biased, and whether statistical adjustment of imbalances in study and patient characteristics across different comparisons in the network of RCTs is appropriate. A major threat to the validity of indirect and mixed treatment comparisons is a difference in modifiers of the relative treatment effect across comparisons, and statistically adjusting for these differences can improve comparability and remove bias. However, adjustment for differences in covariates across comparisons that are not effect modifiers is not necessary and can even introduce bias. As a special case, we outline that adjustment for the baseline risk might be useful to improve similarity and consistency, but may also bias findings. DAGs are useful to evaluate conceptually the assumptions underlying indirect and mixed treatment comparison, to identify sources of bias and guide the implementation of analytical methods used for network meta-analysis of RCTs.

Identifying Clinical Trials in the Medical Literature with Electronic Databases: MEDLINE Alone Is Not Enough

Article

Nov 2000
Contr Clin Trials

The objective of this study was to compare the performance of MEDLINE and EMBASE for the identification of articles regarding controlled clinical trials (CCTs) published in English and related to selected topics: rheumatoid arthritis (RA), osteoporosis (OP), and low back pain (LBP). MEDLINE and EMBASE were searched for literature published in 1988 and 1994. The initial selection of papers was then reviewed to confirm that the articles were about CCTs and to assess the quality of the studies. Selected journals were also hand searched to identify CCTs not retrieved by either database. Overall, 4111 different references were retrieved (2253 for RA, 978 for OP, and 880 for LBP); 3418 (83%) of the papers were in English. EMBASE retrieved 78% more references than MEDLINE (2895 versus 1625). Overall, 1217 (30%) of the papers were retrieved by both databases. Two hundred forty-three papers were about CCTs. Two-thirds of these were retrieved by both databases, and one-third by only one. An additional 16 CCTs not retrieved by either database were identified through hand searching. Taking these into account, EMBASE retrieved 16% more CCTs than MEDLINE (220 versus 188); the EMBASE search identified 85% of the CCTs compared to 73% by MEDLINE. No significant differences were observed in the mean quality scores and sample size of the CCTs missed by MEDLINE compared to those missed by EMBASE. Our findings suggest that the use of MEDLINE alone to identify CCTs is inadequate. The use of two or more databases and hand searching of selected journals are needed to perform a comprehensive search. Control Clin Trials 2000;21:476–487

Why it is important to include unpublished data in systematic reviews

Article

Jun 2011

It is known that studies with statistically significant results have a higher probability to be published (publication bias). Therefore, studies with no statistically significant differences (or not favoring the investigational drug) may not be found in commonly accessed databases and remain unpublished. Moreover, unpublished data may also refer to information that are not included in study reports published in scientific journals but that may be important to estimate study outcomes. Retrieving unpublished evidence represents a compelling challenge for researchers, and in the present paper we explore how to do it.

Estimating Time to Conduct a Meta-analysis From Number of Citations Retrieved

Article

Sep 1999

Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses? Lancet

Article

Nov 2000

The inclusion of only a subset of all available evidence in a meta-analysis may introduce biases and threaten its validity; this is particularly likely if the subset of included studies differ from those not included, which may be the case for published and grey literature (unpublished studies, with limited distribution). We set out to examine whether exclusion of grey literature, compared with its inclusion in meta-analysis, provides different estimates of the effectiveness of interventions assessed in randomised trials. From a random sample of 135 meta-analyses, we identified and retrieved 33 publications that included both grey and published primary studies. The 33 publications contributed 41 separate meta-analyses from several disease areas. General characteristics of the meta-analyses and associated studies and outcome data at the trial level were collected. We explored the effects of the inclusion of grey literature on the quantitative results using logistic-regression analyses. 33% of the meta-analyses were found to include some form of grey literature. The grey literature, when included, accounts for between 4.5% and 75% of the studies in a meta-analysis. On average, published work, compared with grey literature, yielded significantly larger estimates of the intervention effect by 15% (ratio of odds ratios=1.15 [95% CI 1.04-1.28]). Excluding abstracts from the analysis further compounded the exaggeration (1.33 [1.10-1.60]). The exclusion of grey literature from meta-analyses can lead to exaggerated estimates of intervention effectiveness. In general, meta-analysts should attempt to identify, retrieve, and include all reports, grey and published, that meet predefined inclusion criteria.

For expert literature searching, call a librarian

Article

Dec 2001

Jessie Mcgowan

Lumley TNetwork meta-analysis for indirect treatment comparisons. Statist Med 21(16): 2313-2324

Article

Aug 2002

Thomas Lumley

I present methods for assessing the relative effectiveness of two treatments when they have not been compared directly in a randomized trial but have each been compared to other treatments. These network meta-analysis techniques allow estimation of both heterogeneity in the effect of any given treatment and inconsistency ('incoherence') in the evidence from different pairs of treatments. A simple estimation procedure using linear mixed models is given and used in a meta-analysis of treatments for acute myocardial infarction.

Beyond Medline: Reducing bias through extended systematic review search

Article

Jan 2003

To evaluate the sensitivity and precision of various extended search methods in identifying randomized controlled trials (RCTs) for systematic reviews. Prospective analysis of extended search methods (specialized databases or trial registries, reference lists, hand-searching, personal communication, and Internet) used in two systematic reviews of RCTs. The gold standard was the total number of RCTs identified by major databases (MEDLINE, EMBASE, etc.) and extended search strategies combined. Sensitivity was the proportion of all known RCTs identified by any extended search method. Precision reflected the proportion of all items uncovered by any extended search method that actually were RCTs. The extended search identified 94 additional RCTs for the systematic reviews beyond those identified with the major databases. Specialized databases and trial registries had the highest sensitivity and precision for the lipid-lowering project (13.6% and 52.7%, respectively; p < .05) followed by scanning of reference lists (7.2% sensitivity and 41.9% precision; p <.05). Hand-searching was more effective than personal communication and Internet searching (1.7% sensitivity and 12.2% precision; p < .05). The acupuncture project had slightly different results, with the specialized databases and trial registries tied with the review of reference lists for highest sensitivity (14.2%). The precision followed the same trend as the lipid-lowering project (17.6% specialized databases; 8.3% reference lists; p < .05). A post-hoc analysis showed that 75 of the 94 RCTs were indexed in the major databases but missed by the major database search. Extended searching identified additional RCTs for the systematic reviews beyond those found in major databases. Specialized databases and trial registries were most effective. An important number of RCTs were missed by the major database search. Timing and accuracy of indexing may explain this finding. The definitive measure, whether there is an association between the method used to uncover RCTs, the quality of the items uncovered and their impact on systematic review results, is yet to be determined.

The librarian's roles in the systematic review process: A case study

Article

Feb 2005

Martha R Harris

QUESTION/SETTING: Although the systematic review has become a research standard, little information addresses the actions of the librarian on a systematic review team. This article is an observational case study that chronicles a librarian's required involvement, skills, and responsibilities in each stage of a real-life systematic review. Examining the review process reveals that the librarian's multiple roles as an expert searcher, organizer, and analyzer form an integral part of the Cochrane Collaboration's criteria for conducting systematic reviews. Moreover, the responsibilities of the expert searcher directly reflect the key skills and knowledge depicted in the "Definition of Expert Searching" section of the Medical Library Association's policy statement, "Role of Expert Searching in Health Sciences Libraries." Although the librarian's multiple roles are important in all forms of medical research, they are crucial in a systematic review. As an expert searcher, the librarian must interact with the investigators to develop the terms required for a comprehensive search strategy in multiple appropriate sources. As an organizer and analyzer, the librarian must effectively manage the articles and document the search, retrieval, and archival processes.

Modeling public health interventions for improved access to the gray literature

Article

Nov 2005
J MED LIBR ASSOC

Much of the useful information in public health (PH) is considered gray literature, literature that is not available through traditional, commercial pathways. The diversity and nontraditional format of this information makes it difficult to locate. The aim of this Robert Wood Johnson Foundation-funded project is to improve access to PH gray literature reports through established natural language processing (NLP) techniques. This paper summarizes the development of a model for representing gray literature documents concerning PH interventions. The authors established a model-based approach for automatically analyzing and representing the PH gray literature through the evaluation of a corpus of PH gray literature from seven PH Websites. Input from fifteen PH professionals assisted in the development of the model and prioritization of elements for NLP extraction. Of 365 documents collected, 320 documents were used for analysis to develop a model of key text elements of gray literature documents relating to PH interventions. Survey input from a group of potential users directed the selection of key elements to include in the document summaries. A model of key elements relating to PH interventions in the gray literature can be developed from the ground up through document analysis and input from members of the PH workforce. The model provides a framework for developing a method to identify and store key elements from documents (metadata) as document surrogates that can be used for indexing, abstracting, and determining the shape of the PH gray literature.

Search and selection methodology of systematic reviews in orthodontics (2000-2004)

Article

Sep 2006

More systematic reviews related to orthodontic topics are published each year, although little has been done to evaluate their search and selection methodologies. Systematic reviews related to orthodontics published between January 1, 2000, and December 31, 2004, were searched for their use of multiple electronic databases and secondary searches. The search and selection methods of identified systematic reviews were evaluated against the Cochrane Handbook's guidelines. Sixteen orthodontic systematic reviews were identified in this period. The percentage of reviews documenting and using each criterion of article searching has changed over the last 5 years, with no recognizable directional trend. On average, most systematic reviews documented their electronic search terms (88%) and inclusion-exclusion criteria (100%), and used secondary searching (75%). Many still failed to search more than MEDLINE (56%), failed to document the database names and search dates (37%), failed to document the search strategy (62%), did not use several reviewers for selecting studies (75%), and did not include all languages (81%). The methodology of systematic reviews in orthodontics is still limited, with key methodological components frequently absent or not appropriately described.

An evaluation of search and selection methods used in dental systematic reviews published in English

Article

Oct 2006
J AM DENT ASSOC

Increasing numbers of systematic reviews are published each year, though little has been done to evaluate their search and selection methodology. The authors searched dental systematic reviews published between Jan. 1, 2000, and July 14, 2005, for descriptions of how researchers used multiple electronic databases and secondary searches. They evaluated search and selection methods of identified systematic reviews against the guidelines found in the 2005 Cochrane Handbook for Systematic Reviews of Interventions. The authors identified 220 unique dental systematic reviews. They found that all aspects of search and selection methodology had improved. In 2005, most systematic reviews documented database names and search dates (90 percent), electronic search terms (95 percent) and inclusion-exclusion criteria (95 percent), and most employed secondary searching (100 percent). Many still failed to search more than MEDLINE (20 percent), document the search strategy (20 percent), use multiple reviewers for selecting studies (25 percent) and include all languages (39 percent). Systematic review methodology is improving, though key components frequently are absent. Reviews should be read critically and in consideration of the methodological flaws.

Handsearching versus electronic searching to identify reports of randomized trials (Cochrane Methodology Review)

Article

Feb 2007

Systematic reviewers need to decide how best to reduce bias in identifying studies for their review. Even when journals are indexed in electronic databases, it can still be difficult to identify all relevant studies reported in these journals. Over 1700 journals have been or are being handsearched within The Cochrane Collaboration to identify reports of controlled trials in order to help address these problems. To review systematically empirical studies, which have compared the results of handsearching with the results of searching one or more electronic databases to identify reports of randomized trials. Studies were sought from The Cochrane Methodology Register (The Cochrane Library, Issue 2, 2002), MEDLINE (1966 to Week 1 July 2002), EMBASE (1980 to Week 25 2002), AMED (1985 to June 2002), BIOSIS (1985 to June 2002), CINAHL (1982 to June 2002), LISA (1969 to July 2002) and PsycINFO (1972 to May 2002). Researchers who may have carried out relevant studies were contacted. A research study was considered eligible for this review if it compared handsearching with searching one or more electronic databases to identify reports of randomized trials. The main outcome measure was the number of reports of randomized trials identified by handsearching as compared to electronic searching. Data were extracted on the electronic database searched, the complexity of electronic search strategy used, the characteristics of the journal reports identified, and the type of trial report identified. Thirty-four studies were included. Handsearching identified between 92% to 100% of the total number of reports of randomized trials found in the various comparisons in this review. Searching MEDLINE retrieved 55%, EMBASE 49% and PyscINFO 67%. The retrieval rate of the electronic database varied depending on the complexity of the search. The Cochrane Highly Sensitive Search Strategy (HSSS) identified 80% of the total number of reports of randomized trials found, searches categorised as 'complex' (including the Cochrane HSSS) found 65% and 'simple' found 42%. The retrieval rate for an electronic search was higher when the search was restricted to English language journals; 62% versus 39% for journals published in languages other than English. When the search was restricted to full reports of randomized trials, the retrieval rate for an electronic search improved: a complex search strategy (including the Cochrane HSSS) retrieved 82% of the total number of such reports of randomized trials. Handsearching still has a valuable role to play in identifying reports of randomized trials for inclusion in systematic reviews of health care interventions, particularly in identifying trials reported as abstracts, letters and those published in languages other than English, together with all reports published in journals not indexed in electronic databases. However, where time and resources are limited, searching an electronic database using a complex search (or the Cochrane HSSS) will identify the majority of trials published as full reports in English language journals, provided, of course, that the relevant journals have been indexed in the database.

Poor reporting and inadequate searches were apparent in systematic reviews of adverse effects

Article

Jun 2008
J CLIN EPIDEMIOL

Systematic reviews incorporating adverse effects are assuming increasing importance as questions raised extend beyond clinical effectiveness to all effects (beneficial and harmful). The aim of this study was to survey the methods used to identify relevant studies for systematic reviews of adverse effects. All records within the Database of Abstracts of Reviews of Effects and the Cochrane Database of Systematic Reviews were scanned for systematic reviews in which the primary outcomes were adverse effects. Two information professionals independently assessed the methods used to identify relevant research as reported in the 277 reviews that met the inclusion criteria. A major weakness of the reviews was inadequate reporting of the search strategies used. In addition, of the reviews that did report a search strategy, few used the sensitive search strategies recommended for systematic reviews. The majority of reviews did not search more than one or two databases, and few other methods of identifying information were used. This investigation shows the variation in the searching element of systematic reviews of adverse effects and demonstrates that the reporting of the methods used to identify research in such reviews could be vastly improved.

Comparative efficacy and acceptability of pharmacological treatments for acute mania: a multiple treatment meta-analysis, in Department of Public Health and Community Medicine Section of Psychiatry

Jan 2011
141

M Purgato
A Cipriani

Purgato M, Cipriani A. Comparative efficacy and acceptability of pharmacological treatments for acute mania: a multiple treatment meta-analysis, in Department of Public Health and Community Medicine Section of Psychiatry 2011, University of Verona. 141.

Handsearching versus electronic searching to identify reports of randomized trials. Cochrane

Jan 2007

S Hopewell
M Clarke
C Lefebvre
R Scherer

Hopewell S, Clarke M, Lefebvre C, Scherer R. Handsearching versus electronic searching to identify reports of randomized trials. Cochrane Database Syst Rev 2007;MR000001.

Cochrane handbook for Systematic Reviews of Interventions 5.1.0 [updated

Mar 2011

J P Higgins

Higgins JP, S G. Cochrane handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011].

Does the inclusion of grey literature influence estimates of intervention effectiveness reported in meta-analyses?.

Jan 2000
1228-1231

McAuley L.
Pham B.
Tugwell P.
Wheatley JA

Network meta-analyses could be improved by searching more sources and by involving a librarian

Abstract

No full-text available

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