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La expansión y consolidación de la práctica clínica basada en la evidencia ha llevado entre otras, a la necesidad de realizar una variedad cada vez mayor de tipos de revisión de la literatura científica; lo que permite avanzar en el conocimiento y comprender la amplitud de la investigación sobre un tema de interés, teniendo en cuenta que una de las propiedades del conocimiento es su carácter acumulativo. Sin embargo, la diversidad de la terminología utilizada genera confusión de términos y conceptos. El objetivo de este manuscrito fue proporcionar un listado de los tipos de revisiones de la literatura más frecuentemente utilizados con sus características y algunos ejemplos de ellas. Revisión cualitativa. Se examinaron de forma dirigida las bases de datos PubMed, WoS y Scopus, en búsqueda de términos asociados a tipos de revisiones y síntesis de la literatura científica. Se encontraron 21 tipos de revisión; y 29 variantes y sinonimias asociadas; las que ilustran los procesos de cada una de ellas. Se da una descripción general de las características de cada cual, junto con las fortalezas y debilidades percibidas. No obstante, se verificó que sólo algunos tipos de revisión poseen metodologías propias y explícitas. Este enfoque, proporciona un punto de referencia para quienes realizan o interpretan revisiones en el ámbito sanitario, y sugiere dos tipos de propuestas de clasificación.
SUMMARY: The expansion and consolidation of evidence-based clinical practice has led, among other things, to the need to carry out an increasing variety of types of literature reviews, which allows advancing in knowledge and understanding the breadth of research on a topic of interest. However, the diversity of the terminology used generates confusion of terms and concepts. The aim of this manuscript was to provide a list of the most frequently used review types with their characteristics and some examples. Qualitative review. PubMed, WoS and Scopus databases were examined in a directed way, searching for terms associated with types of reviews and syntheses of the scientific literature. Twenty-one types of review, and 29 variants and associated synonymies were found; those that illustrate the processes of each of them. An overview of the characteristics of each is given, along with perceived strengths and weaknesses. However, it was verified that only some types of review have their own explicit methodologies. This approach, provides a point of reference for those who perform or interpret reviews in the health field and suggests two classification proposals.
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Review Literature as Topic , Meta-Analysis as Topic , Evidence-Based Medicine , Systematic Reviews as TopicABSTRACT
El aumento de la producción de investigación primaria y de las revisiones de la literatura durante las últimas décadas ha hecho necesario el desarrollo de un nuevo diseño metodológico para sintetizar la evidencia: los overviews. Un overview es un diseño de síntesis de evidencia que toma como unidad de análisis a las revisiones sistemáticas, con el objetivo de extraer y analizar los resultados para una pregunta de interés nueva o más amplia, ayudando así a mejorar los procesos de toma de decisiones informadas. El objetivo de este artículo es introducir al lector a este tipo de resúmenes de evidencia, destacando las diferencias con los otros tipos de síntesis de evidencia, los aspectos metodológicos particulares de los overviews, y los desafíos pendientes. Este artículo es el duodécimo de una serie metodológica colaborativa de revisiones narrativas sobre temáticas de bioestadística y epidemiología clínica.
The increasing production of primary research and literature reviews in the last decades has made it necessary to develop a new methodological design to synthesize the evidence: the overviews. An overview is a type of evidence synthesis that uses systematic reviews as the unit of analysis, with the aim of extracting and analyzing the results for a new or broader research question, helping the shared decision-making processes. The aim of this article is to introduce the reader to this type of evidence summaries, highlighting the differences between overviews and other types of synthesis, the unique methodological aspects of overviews, and future challenges. This is the twelfth article from a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology.
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SUMMARY OBJECTIVE: The aim of this study was to identify the frequency of Cochrane systematic reviews and Cochrane systematic reviews protocols using (or planning to use) the risk of bias 2.0 tool to assess the risk of bias of the included randomized clinical trials. STUDY DESIGN: This is a meta-research study. METHODS: We included Cochrane systematic reviews or Cochrane systematic reviews protocols that planned to include randomized clinical trials. We assessed the Cochrane Database of Systematic Reviews and screened for issues published after the launch of risk of bias 2.0 tool (2019-2022). Two independent investigators performed the study selection and data extraction. RESULTS: We analyzed 440 Cochrane systematic reviews and 536 Cochrane systematic reviews protocols. Overall, 4.8% of the Cochrane systematic reviews and 28.5% of the Cochrane systematic reviews protocols used or planned to use risk of bias 2.0 tool. Although low, adherence is increasing over time. In 2019, 0% of Cochrane systematic reviews used risk of bias 2.0 tool, compared to 24.1% in 2022. In Cochrane systematic reviews protocols, adherence increased from 6.9% in 2019 to 41.5% in 2022. A total of 274 (62.1%) Cochrane systematic reviews had their protocols published before 2018; only one used risk of bias 2.0 tool and reported the change of versions in the "Differences between protocol and revision" section. CONCLUSION: The Cochrane's risk of bias 2.0 tool has low adherence among Cochrane protocols and systematic reviews. Further efforts are necessary to facilitate the implementation of this new tool.
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Resumen Se reseña la presentación del libro Historia de la pediatría militar.
Abstract Review of the presentation of the book Historia de la pediatría militar.
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OBJECTIVE@#To re-evaluate the systematic review/Meta-analysis of acupuncture and moxibustion for childhood autism (CA), aiming to provide decision-making basis for clinical diagnosis and treatment.@*METHODS@#The systematic review and/or Meta-analysis of acupuncture and moxibustion for CA were searched in PubMed, EMbase, Cochrane Library, SinoMed, CNKI and Wanfang databases. The retrieval time was from the database establishment to May 5th, 2022. PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and AMSTAR 2 (a measurement tool to assess systematic reviews 2) was used to evaluate the methodological quality, bubble map was used to construct the evidence map and GRADE was used to evaluate the quality of evidence.@*RESULTS@#A total of 9 systematic reviews were included. The PRISMA scores ranged from 13 to 26. The report quality was low, and there was a serious lack in the aspects of program and registration, search, other analysis and funding. The main problems in methodology included not making prespecified protocol, incomplete retrieval strategy, not providing a list of excluded literatures, and incomplete explanation on heterogeneity analysis and bias risk. The evidence map showed that 6 conclusions were valid, 2 conclusions were possible valid and 1 conclusion was uncertain valid. The overall quality of evidence was low, and the main factors leading to the downgrade were limitations, followed by inconsistency, imprecision and publication bias.@*CONCLUSION@#Acupuncture and moxibustion has a certain effect for CA, but the quality of reporting, methodology and evidence in included literature need to be improved. It is suggested to perform high-quality and standardized research in the future to provide evidence-based basis.
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Child , Humans , Acupuncture Therapy/methods , Autistic Disorder , Moxibustion/methods , Publication Bias , Research Design , Systematic Reviews as Topic , Meta-Analysis as TopicABSTRACT
Diabetic retinopathy (DR) is one of common and specific microvascular complications caused by diabetic mellitus, and remains a serious and common ocular complication leading preventable blindness. At present, the specific pathogenesis of DR is not completely clear, and many factors are involved in its occurrence and development. Adiponectin (APN) is an endogenous cytokine secreted by adipocytes. It is expressed in all layers of retina, especially in the outer layer (rods and cones). It is involved in regulating fatty acid oxidation and glucose metabolism by binding with specific receptors. In recent years, a lot of studies have found that APN can be involved in regulating blood glucose, inhibiting neovascularization, reducing inflammation, dilating blood vessels and improving vascular endothelial function. At present, the specific mechanism of APN in the occurrence and development of DR Remains to be determined. Further research on the level changes and the specific mechanism of action of APN in DR may help to identify the characteristic metabolic changes of DR, thus providing new biomarkers for the diagnosis of DR, while helping to promote the innovation of the treatment of DR.
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Objective:To systematically review the association between delivery mode and exclusive breastfeeding rate during hospitalization and within the first six months of life.Methods:Observational studies on the association between delivery mode and feeding pattern were searched from PubMed, Web of Science, Cochrane Library, EBSCO, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database from inception to October 2022. Two independent reviewers screened the literature, extracted data, and assessed the quality of included studies using Critical Appraisal Tools published by Joanna Briggs Institute or Newcastle-Ottawa Quality Scale (NOS). This meta-analysis was performed using R 4.1.0 software. Fixed-effect or random-effect models were used to pool data. Egger test and funnel plot were used to assess publication bias.Results:A total of 34 studies involving 597 203 subjects were included, including 22 cross-sectional studies and 12 cohort studies. All of the 22 cross-sectional studies were B-level quality, and eleven out of the 12 included cohort studies scored 7 points or above on the NOS scale with high quality. The results of meta-analysis showed that the likelihood of exclusive breastfeeding during hospitalization of women who had cesarean section was lower than those who delivered vaginally ( OR=0.33, 95% CI: 0.22-0.50, P<0.001); and so was the likelihood of exclusive breastfeeding at six months postpartum ( OR=0.61, 95% CI: 0.47-0.79, P<0.001). Conclusion:Current evidence suggests that cesarean section is a disadvantage to exclusive breastfeeding during hospitalization and within six months after delivery.
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The American Urological Association (AUA), European Association of Urology (EUA) and International Urological Society (SIU) annual meetings were held in 2022. Studies on prostate cancer reported in the meetings mainly focus on the advances of diagnostic biomarkers (such as α-2, 3-1inked sialylation of terminal N-glycan on free PSA density, SelectMDx) and imaging techniques [such as multiparametric magnetic resonance imaging, prostate specific membrane antigen(PSMA)-PET/CT], the new method for prostate biopsy, the new treatments of prostate cancer including [177Lu] Ludotadipep and DROP-IN PSMA probe, and the prognosis assessment of prostate cancer (such as AR-V7). This article provides an overview on the research hotspots of three international academic meetings.
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Male , Humans , Urology , Positron Emission Tomography Computed Tomography/methods , Prostatic Neoplasms/pathology , Multiparametric Magnetic Resonance Imaging/methods , Gallium RadioisotopesABSTRACT
OBJECTIVE@#To assess the methodological quality, report quality and evidence quality of the Meta-analysis and systematic reviews of acupuncture and moxibustion for children with cerebral palsy, aiming to provide decision-making basis for clinical treatment.@*METHODS@#The systematic reviews and Meta-analysis of acupuncture and moxibustion for children with cerebral palsy were searched in CNKI, Wanfang, VIP, SinoMed, Cochrane Library, PubMed and EMbase. The retrieval time was from the database establishment to June 30th, 2022. AMSTAR 2 (a measurement tool to assess systematic reviews) was used to evaluate the methodological quality， and PRISMA (preferred reporting items for systematic reviews and Meta-analyses) was used to evaluate the report quality, and GRADE was used to evaluate the quality of evidence.@*RESULTS@#A total of 14 systematic reviews were included, including 37 primary outcome indexes. According to AMSTAR 2 evaluation results, there were 4 low quality studies, 10 very low quality studies, and low scores on items 2, 4, 7, 10 and 16. PRISMA scores ranged from 15 to 25, and the main reporting problems reflected in structured abstracts, program and registration, retrieval, and funding sources, etc. According to the GRADE classification results, there were 3 high quality evidences, 7 medium quality evidences, 10 low quality evidences and 17 very low quality evidences. The main downgrading factors were limitations, imprecision and publication bias.@*CONCLUSION@#Acupuncture and moxibustion has a certain effect for cerebral palsy in children, but the quality of methodology, reporting and evidence in the included literature is poor, and the comparison of curative effect between different acupuncture and moxibustion methods is unclear.
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Child , Humans , Acupuncture Therapy/methods , Cerebral Palsy/therapy , Moxibustion/methods , Publication Bias , Research Report , Systematic Reviews as Topic , Meta-Analysis as TopicABSTRACT
Introduction: Patients often refer to information on the Internet when selecting a medical institution, and some patients provide feedback on their experiences. In this study, we analyzed the content of patients' evaluations of medical institutions on Google.Methods: This study evaluated Google reviews and ratings of medical institutions in Shizuoka Prefecture. We coded the reviews with 12 items according to their content, and further categorized them into "positive," "negative," "unclassifiable," and "no description." We used modified Poisson regression analysis to investigate the relationship between ratings and assessment items.Results: Our sample consisted of 2,044 medical institutions. The number of reviews included in the analysis was 13,769. Reviews frequently commented on "doctor's behaviors," and positive comments about doctor's behaviors were significantly associated with high ratings (B: 0.76, 95%CI: 0.70 to 0.82), whereas negative comments were associated with low ratings (−4.65, −5.24 to −4.06).Conclusion: Within the reviews on Google, doctors' behavior had an impact on the ratings of medical institutions.
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ObjectiveTo re-evaluate the systematic reviews/Meta-analyses （SRs/MAs） of tonic traditional Chinese medicine （TCM） injections against cerebral ischemic stroke （CIS） and provide evidence support for clinical practice and decision-making. MethodTCM injections of different varieties were obtained after searching the three major drug catalogues. Seven Chinese and English databases were searched from database inception to March 13，2022，for the relevant SRs/MAs. The methodological quality，risk of bias，reporting quality，and quality of evidence were assessed by Assessment of Multiple Systematic Reviews-2 （AMSTAR-2），the Risk of Bias in Systematic Review （ROBIS），the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 （PRISMA 2020），and the Grading of Recommendations Assessment，Development，and Evaluation （GRADE）. In addition，the literature overlap matrix was established to calculate the corrected covered area （CCA） and evaluate the rate of overlaps of the original literature. ResultFive types of TCM injections and 18 SRs/MAs were included. AMSTAR 2 evaluation showed that the methodological quality of 18 SRs/MAs was extremely low，and 14 SRs/MAs had a high risk of bias assessed by ROBIS. The quality evaluation results reported by the PRISMA 2020 showed that the scores of the studies included ranged from 19.5 to 28.5，with 10 being of medium quality and eight of low quality. The evaluation with the GRADE system demonstrated that one outcome was moderate-quality evidence，15 outcomes were low-quality evidence，and 41 outcomes were very low-quality evidence. The CCA of the included SRs/MAs was 0.263，indicating a low rate of overlaps of the original literature. ConclusionTonic TCM injections are effective and safe in the treatment of CIS，but this conclusion should be treated with caution because of the low quality of methodology，reports，and evidence in published SRs/MAs. It is recommended to improve the study design，obtain clinical evidence of higher quality，and conduct systematic evaluations in strict accordance with procedures to standardize the reporting of research results.
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ObjectiveTo systematically evaluate the safety of Chinese medicines combined with Tripterygium wilfordii polyglycoside tablets/Tripterygium wilfordii tablets （TWPT/TWT） in the treatment of rheumatoid arthritis （RA）， and to explore the network regulatory mechanisms of enhancing efficacy and reducing toxicity of commonly used combination regimes. MethodThe literature involving the adverse reactions of TWPT/TWT in treating RA was searched and collected from three Chinese databases （CNKI， Wanfang Data， VIP） and three English databases （PubMed， Cochrane Library， Embase） from the inception of the databases to July 2021. All studies were assessed by the Cochrane risk of bias tool， and the data were extracted and analyzed by Stata 15.0. Furthermore， Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine 2.0 （TCMIP v2.0，http：//www.tcmip.cn/） was used to construct a "drug target-symptom gene of efficacy and toxicity" interaction network， to explore the underlying network regulatory mechanisms of enhancing efficacy and reducing toxicity of common T. wilfordii preparation combinations. ResultA total of 2 132 articles on Chinese medicines combined with TWPT/TWT in the treatment of RA were retrieved， and 18 of them were finally included. The systematic review showed that the adverse reactions of TWPT/TWT against RA mainly occurred in the digestive system， blood system， and reproductive system， of which digestive system had the highest incidence of damages. However， the combination with Chinese medicines effectively alleviated the adverse reactions caused by TWPT/TWT ［RR （95% CI）=0.45 （0.30， 0.66）， P<0.01］. In addition， the subgroup analysis indicated that the age of RA patients， course of disease， combination regimen， medication dosage and duration of treatment all affected the occurrence of adverse reactions of TWPT/TWT. It was found in clinical studies that total glucosides of paeony （TGP） and TWPT/TWT was most widely combined， and the effect of TGP in reducing TWPT/TWT-induced hepatotoxicity was also more significant than that of other Chinese medicines. Moreover， taking this combination regime as an example， this paper explored the "efficacy-toxicity" association mechanisms of TGP-TWPT/TWT against RA. The "drug target-symptom gene of efficacy and toxicity" interaction network revealed that the core network targets of TGP-TWPT/TWT enhanced efficacy and reduced toxicity mainly through regulating immunity-inflammation-related pathways， metabolic pathways and cell signal transduction. Especially， interleukin-4 （IL-4） and interleukin-13 （IL-13）， which were involved in the "immunity-inflammation" module， were the common targets of TGP-TWPT/TWT to enhance efficacy and reduce toxicity. The endogenous sterols， bile acids and bile salts， insulin secretion and other metabolic pathways in the "body metabolism" module were closely associated with the mechanisms of TWPT/TWT inducing hepatotoxicity and TGP reducing hepatotoxicity. While cell function regulation pathways， such as stem cell factor （SCF）/tyrosine kinase receptor （KIT） signaling pathway and phosphatidylinositol 3-kinase （PI3K）/protein kinase B （Akt）signaling pathway were involved in both anti-RA effects and hepatotoxicity of TWPT/TWT. ConclusionClinical application of suitable Chinese medicines combined with TWPT/TWT in the treatment of RA can effectively improve the rheumatism and reduce the adverse reactions of TWPT/TWT， and TGP-TWPT/TWT has the most significant toxicity-reducing effect. Further biological network-based investigation indicates that the toxicity-reducing mechanism of TGP-TWPT/TWT may be related to the regulation of interleukin signaling pathway and bile acid metabolism pathway， and the synergistic efficacy-enhancing effect of the combination may be achieved by acting on interleukin signaling pathway and cell function regulation pathway.
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OBJECTIVE To provide a reference for strengthening the post-admission management of drugs on the medicare formulary in China. METHODS The basic situation， implementation process and effect of post-market reviews （PMR） were introduced after marketing approval of the Australian pharmaceutical benefits scheme （PBS） subsidized medicines. The suggestions were put forward for post-admission management of medicare formulary drugs in China. RESULTS & CONCLUSIONS PMR system exemplified Australia’s concept of life-cycle management of medicines on the PBS catalogue； as a mechanism for managing the admission and adjustment of PBS medicines， it provided a continuous evaluation of medicines in the PBS catalogue； the process mainly included two types： the pre-initiation process of PBS drug review and the PBS drug review process， involving steps such as drug selection， determination of review scope， and implementation management. Through PMR， Australia had completed the review of multiple medicines in nine treatment areas including diabetes， childhood asthma and Alzheimer’s disease in the PBS catalogue. The author suggests that China can improve the post-admission review of medicines at the institutional level （clarifying the selection criteria and methods of the review object， main procedures and responsible parties， and ensuring the transparency of the review process）； specify the National Healthcare Security Administration or the third-party organization until a special technical organization is established to take charge of this work； at the same time， further improve the construction of data collection and monitoring systems.
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OBJECTIVE To reevaluate systematic reviews/meta-analysis of efficacy and safety of tolvaptan for hyponatremia. METHODS Retrieved from CNKI， Wanfang Data， VIP， CBM， PubMed， Embase and the Cochrane Library database， systematic reviews/meta-analysis about tolvaptan for the treatment of hyponatremia were included from the inception to June 15， 2022. After screening literature and extracting data， the PRISMA statement， AMSTAR 2 scale and GRADE method were used to evaluate the reporting quality， methodological quality and evidence quality of the included literature， respectively. RESULTS A total of 6 articles were included， of which 1 was systematic review and 5 were meta-analysis， including 56 outcome indicators. All of the 6 studies had PRISMA scores ranging from 15.0 to 20.5， and the quality of them was moderate. Results of the AMSTAR 2 scale showed that the methodological quality of 5 literatures were very low， and the quality of 1 literature was low. The quality of GRADE evidence showed that there were 6 moderate-quality indicators， 13 low-quality indicators， 35 very low-quality indicators， and 2 indicators that could not be assessed due to missing data. The main factors causing degradation were limitations， inconsistency， imprecision and publication bias. In terms of efficacy， tolvaptan could effectively increase the level of serum sodium， increase urine volume， reduce body weight， reduce abdominal circumference， relieve edema， and reduce alaninetransaminase level. In terms of safety， the incidence of total adverse drug reaction induced by tolvaptan was controversial； it may increase the risk of dry mouth， thirst， frequent urination or excessive correction of serum sodium. CONCLUSIONS Tolvaptan has great efficacy in the treatment of hyponatremia， but serum sodium overcorrection should be avoided in terms of safety. Relevant systematic reviews/meta-analysis have shortcomings of low reporting quality， methodological quality and evidence quality， which may reduce the reliability of the results， so the results should be treated with caution.
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Abstract Background The etiology of systemic lupus erythematosus is complex and incurable. A large number of systematic reviews have studied the risk factors of it. Mendelian randomization is an analytical method that uses genetic data as tool variables to evaluate the causal relationship between exposure and outcome. Objective To review the systematic reviews and Mendelian randomization studies that focused on the risk factors of systemic lupus erythematosus and shed light on the development of treatments for its prevention and intervention. Methods From inception to January 2022, we systematically searched MEDLINE (via PubMed) and Embase for related systematic reviews and Mendelian randomization studies. Extract relevant main data for studies that meet inclusion criteria. The quality of systematic reviews was assessed by using Assessment of Multiple Systematic Reviews 2 (AMSTAR-2). Finally, the risk factors are scored comprehensively according to the results' quantity, quality, and consistency. Results Our study involved 64 systematic reviews and 12 Mendelian randomization studies. The results of systematic reviews showed that diseases (endometriosis, atopic dermatitis, allergic rhinitis), lifestyle (smoking, drinking, vaccination), and gene polymorphism influenced the incidence of systemic lupus erythematosus. The results of Mendelian randomization studies identified the role of disease (periodontitis, celiac disease), trace elements (selenium, iron), cytokines (growth differentiation factor 15), and gut microbiome in the pathogenesis of systemic lupus erythematosus. Conclusion We should pay attention to preventing and treating systemic lupus erythematosus in patients with endometriosis, celiac disease, and periodontitis. Take appropriate dietary supplements to increase serum iron and selenium levels to reduce the risk of systemic lupus erythematosus. There should be no excessive intervention in lifestyles such as smoking and drinking.
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ABSTRACT BACKGROUND: Carpal tunnel syndrome (CTS) is a common condition greatly affects patients' quality of life and ability to work. Systematic reviews provide useful information for treatment and health decisions. OBJECTIVE: This study aimed to assess the methodological quality of previously published systematic reviews on the treatment of CTS. DESIGN AND SETTING: Overview of systematic reviews conducted at the Brazilian public higher education institution, São Paulo, Brazil METHODS: We searched the MEDLINE and Cochrane Library database for systematic reviews investigating the treatment of CTS in adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and measurement tool to assess systematic reviews (AMSTAR) were applied by two independent examiners. RESULTS: Fifty-five studies were included. Considering the stratification within the AMSTAR measurement tool, we found that more than 76% of the analyzed studies were "low" or "very low". PRISMA scores were higher when meta-analysis was present (15.61 versus 10.40; P = 0.008), while AMSTAR scores were higher when studies performed meta-analysis (8.43 versus 5.59; P = 0.009) or when they included randomized controlled trials (7.95 versus 6.06; P = 0.043). The intra-observer correlation demonstrated perfect agreement (> 0.8), a Spearman's correlation coefficient of 0.829, and an ICC of0.857. The inter-observer correlation indicated that AMSTAR was more reliable than PRISMA. CONCLUSION: Overall, systematic reviews of the treatment of CTS are of poor quality. Reviews with better-quality conducted meta-analysis and included randomized controlled trials. AMSTAR is a better tool than PRISMA because it has a better performance and should be recommended in future studies. REGISTRATION NUMBER IN PROSPERO: CRD42020172328 (https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42020172328)
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Resumo Fundamento O significado prognóstico dos indicadores nutricionais em pacientes com insuficiência cardíaca com fração de ejeção preservada (ICFEP) não é claro. Objetivo Esta revisão sistemática e metanálise teve como objetivo avaliar o valor prognóstico da albumina sérica (AS), o índice de risco nutricional geriátrico (IRNG) e o índice nutricional prognóstico (INP) em pacientes com ICFEP. Método Os bancos de dados PubMed, Embase, The Cochrane Library e Web of Science foram sistematicamente pesquisados para todos os estudos publicados até janeiro de 2022. O significado prognóstico de IRNG, GNRI e INP para ICFEP foi explorado. A taxa de risco agrupada (HR) e o intervalo de confiança (IC) de 95% foram estimados usando o software STATA 15.0. A Ferramenta de Estudos de Qualidade de Prognóstico foi usada para avaliar a qualidade dos estudos. Resultados Nove estudos preencheram os critérios de inclusão e 5.603 adultos com ICFEP foram incluídos na metanálise. As análises mostraram que uma diminuição de AS ou IRNG estava significativamente relacionada à alta mortalidade por todas as causas (HR: 1,98; 95% IC: 1,282-3,057; p = 0,002; e HR: 1,812;95% IC: 1,064-3,086; p = 0,029, respectivamente). Além disso, uma AS mais baixa indica um resultado composto ruim de mortalidade por todas as causas e reinternação por IC (HR: 1,768; IC 95%: 1,483-2,108; p = 0,000), e um IRNG mais baixo foi significativamente associado a alta mortalidade cardiovascular (HR: 1,922; 95% IC: 1,504-2,457; p = 0,000). No entanto, um INP mais baixo não se correlacionou com mortalidade por todas as causas (HR: 1,176; IC 95%: 0,858-1,612, p=0,314). Conclusões Nossa metanálise indica que AS e IRNG podem ser indicadores úteis para prever o prognóstico de pacientes com ICFEP.
Abstract Background The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear. Objectives This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF. Methods Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies. Results Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314). Conclusions Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.
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RESUMEN Este informe tiene por objetivo exponer el trabajo realizado sobre el diseño, la publicación y el impacto de las actualizaciones para intervenciones en COVID-19 basadas en la evidencia, para brindar síntesis de evidencia actualizadas a partir de revisiones sistemáticas vivas sobre intervenciones terapéuticas para dar soporte en la toma de decisiones. Para ello, se generó un grupo específico de trabajo en el ámbito de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC) en el Ministerio de Salud de Argentina en colaboración con la Organización Panamericana de la Salud (OPS). Se diseñó una metodología para elaborar y publicar documentos de evaluación orientados a dar apoyo en la toma de decisiones. Estos informes de actualización se respaldaron en la exploración de tres dominios: los efectos en la salud, la factibilidad de la implementación y las recomendaciones basadas en evidencia. Las conclusiones se adaptaron en un esquema semaforizado según el balance entre los beneficios y los aspectos negativos para los distintos escenarios clínicos, a fin de mejorar su interpretación y aplicación. Durante el año 2021 se publicaron 16 informes de síntesis de evidencia (13 originales y 3 actualizaciones completas) que recibieron un destacado número consultas desde la página web de CONETEC y la Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas (BRISA). Así se hizo visible la necesidad de disponer de resúmenes de evidencia robustos, actualizados y confiables con adaptación al contexto de aplicación en el sistema sanitario del país. El desafío se presenta, además, en la actualización constante de la información, la diseminación apropiada y el sostenimiento en la rigurosidad en el desarrollo de los informes.
ABSTRACT This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.
RESUMO Este relatório tem como objetivo apresentar o trabalho realizado sobre o delineamento, publicação e impacto das atualizações para intervenções em COVID-19 baseadas em evidências, que visam fornecer sínteses de evidências atualizadas provenientes de revisões sistemáticas vivas sobre intervenções terapêuticas para apoiar a tomada de decisões. Para isso, foi criado um grupo de trabalho específico no âmbito da Comissão Nacional de Avaliação de Tecnologias de Saúde (CONETEC, na sigla em espanhol), do Ministério da Saúde da Argentina, em parceria com a Organização Pan-Americana da Saúde (OPAS). Foi desenhada uma metodologia para a elaboração e publicação de documentos de avaliação destinados a apoiar a tomada de decisões. Esses relatórios de atualização se basearam na exploração de três domínios: efeitos na saúde, viabilidade da implementação e recomendações baseadas em evidências. As conclusões foram adaptadas a uma escala semafórica de acordo com o equilíbrio entre os benefícios e os aspectos negativos para os diferentes cenários clínicos, de forma a melhorar a sua interpretação e aplicação. Durante o ano de 2021, foram publicados 16 relatórios de síntese de evidências (13 originais e 3 atualizações completas), que receberam um número significativo de consultas no site da CONETEC e da Base Regional de Informes de Avaliação de Tecnologias em Saúde das Américas (BRISA). Assim, tornou-se visível a necessidade de contar com resumos de evidências robustos, atualizados e confiáveis adaptados ao contexto de aplicação no sistema de saúde do país. A atualização constante das informações, sua divulgação adequada e a manutenção do rigor na elaboração dos relatórios também apresentam desafios.
Subject(s)
Humans , Technology Assessment, Biomedical , Clinical Decision-Making , COVID-19/therapy , Argentina , Advisory Committees , Systematic Reviews as TopicABSTRACT
ABSTRACT Optimal clinical decision-making requires understanding of evidence regarding benefits, harms, and burdens of alternative management options. Rigorously conducted systematic reviews and meta-analyses offer accurate summaries of the evidence. However, such summaries may review only low-certainty evidence, in the process highlighting that no single decision is likely to be best for all patients. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach offers a systematic and transparent method for rating certainty of evidence in systematic reviews. In this paper, we will address the importance of assessing the certainty associated with bodies of evidence; explain how the GRADE system rates the certainty of evidence from systematic reviews; and present the GRADE evidence to decision framework for moving from evidence to strong or weak recommendations in clinical practice guidelines.
RESUMO Para tomar a melhor decisão clínica, é preciso compreender as evidências a respeito dos benefícios, malefícios e ônus das alternativas de manejo. Revisões sistemáticas e meta-análises que sejam realizadas com rigor oferecem resumos precisos das evidências. No entanto, é possível que esses resumos avaliem apenas as evidências cujo grau de certeza é baixo e, ao fazê-lo, ressaltem que provavelmente não existe uma decisão única que será a melhor para todos os pacientes. O Grading of Recommendations Assessment, Development, and Evaluation (GRADE) é um método sistemático e transparente para avaliar o grau de certeza das evidências em revisões sistemáticas. Neste artigo, abordaremos a importância de avaliar o grau de certeza das evidências; explicaremos como o sistema GRADE classifica o grau de certeza das evidências provenientes de revisões sistemáticas e apresentaremos o evidence to decision framework (quadro para a avaliação de evidências) do GRADE para decidir se as evidências se traduzem em recomendações fortes ou fracas nas diretrizes de prática clínica.
ABSTRACT
Aim: This study aimed to assess the reporting characteristics of systematic review abstracts published in the proceedings of the Sociedade Brasileira de Pesquisa Odontológica (SBPqO) meeting. Methods: We selected abstracts published in the SBPqO meeting proceedings of 2019 and 2020, mentioning that a systematic review was conducted in the title, objective or methods sections. One researcher performed the screening and the data extraction after a pilot test training. The following data were extracted: affiliation of the primary author, dental specialization, the term "systematic review" mentioned in the title, reporting of the objective, reporting of eligibility criteria, reporting of information sources, reporting of the number of included studies and if a meta-analysis was performed. A descriptive analysis of the data was performed with data summarized as frequencies. Results: We included 235 abstracts. A total of 20 studies were from the Universidade de Uberlândia (8.5%), and the main specialization was Restorative and Esthetic Dentistry, with 47 studies (20%). Most of the studies mentioned the term "systematic review" in the title (n=219; 93.2%) and reported the objective (n=231; 98.3%). A great majority of studies did not report the eligibility criteria (n=97; 41.3%) or it was classified as unclear (n=96; 40.8%). The great majority of studies only reported the databases searched (n=103; 43.8%) or databases and date of search (n=74; 31.5%). Most of the studies reported the number of included studies (n=204; 86.8%). Conclusion: Based on this study, the reporting characteristics of systematic review abstracts published in the proceedings of the SBPqO meeting are satisfactory. However, there is room for improvement