Most systematic reviews reporting adherence to AMSTAR 2 had critically low methodological quality: a cross-sectional meta-research study.

OBJECTIVES: To analyze the methodological quality and characteristics of systematic reviews (SRs) that reported they were conducted in line with the AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews). STUDY DESIGN AND SETTING: This was a cross-sectional meta-research study. We searched MEDLINE and Embase. We included full reports of SRs reporting the study was conducted, prepared, or designed in line with the AMSTAR 2. Eligible SRs were those published from January 1, 2018, until May 3, 2022. We assessed the methodological quality of the included SRs using AMSTAR 2. RESULTS: We included a total of 45 records. There were 43 SRs and 2 SR protocols. Among them, most were SRs of interventions that included primary studies on humans. More than half had a meta-analysis. According to our overall AMSTAR 2 assessments of included SRs, 35 SRs were of critically low confidence, 7 SRs were of low confidence, and one SR was of high confidence. There were no SRs of moderate confidence. CONCLUSION: Even when authors indicate in their manuscripts that the SR was conducted/prepared/designed in line with the AMSTAR 2, it does not necessarily imply it is of high or even moderate confidence according to AMSTAR 2. A self-assessment with AMSTAR 2 could be required for submission and carefully checked by the editors/peer reviewers.

Adopting AMSTAR 2 critical appraisal tool for systematic reviews: speed of the tool uptake and barriers for its adoption.

BACKGROUND: In 2007, AMSTAR (A MeaSurement Tool to Assess systematic Reviews), a critical appraisal tool for systematic reviews (SRs), was published, and it has since become one of the most widely used instruments for SR appraisal. In September 2017, AMSTAR 2 was published as an updated version of the tool. This mixed-methods study aimed to analyze the extent of the AMSTAR 2 uptake and explore potential barriers to its uptake. METHODS: We analyzed the frequency of AMSTAR or AMSTAR 2 use in articles published in 2018, 2019 and 2020. We surveyed authors who have used AMSTAR but not AMSTAR 2 in the analyzed time frame to identify their reasons and barriers. The inclusion criterion for those authors was that the month of manuscript submission was after September 2017, i.e. after AMSTAR 2 was published. RESULTS: We included 871 studies. The majority (N = 451; 52%) used AMSTAR 2, while 44% (N = 382) used AMSTAR, 4% (N = 31) used R-AMSTAR and others used a combination of tools. In 2018, 81% of the analyzed studies used AMSTAR, while 16% used AMSTAR 2. In 2019, 52% used AMSTAR, while 44% used AMSTAR 2. Among articles published in 2020, 28% used AMSTAR, while AMSTAR 2 was used by 69%. An author survey indicated that the authors did not use AMSTAR 2 mostly because they were not aware of it, their protocol was already established, or data collection completed at the time when the new tool was published. Barriers towards AMSTAR 2 use were lack of quantitative assessment, insufficient awareness, length, difficulties with a specific item. CONCLUSION: In articles published in 2018-2020, that were submitted to a journal after AMSTAR 2 tool was published, almost half of the authors (44%) still used AMSTAR, the old version of the tool. However, the use of AMSTAR has been declining in each subsequent year. Our survey indicated that editors and peer-reviewers did not ask the authors to use the new version of the tool. Few barriers towards using AMSTAR 2 were identified, and thus it is anticipated that the use of the old version of AMSTAR will continue to decline.

Laparoscopic Versus Open High Ligation for Adolescent Varicocele: A 6-year Single Center Study.

OBJECTIVE: The aim of this study was to compare the outcomes of high ligation in adolescents with varicocele between open and laparoscopic surgical approaches. DESIGN: Retrospective study. SETTING: The study was conducted from January 2012 to January 2018, with median follow-up of 36 months, in the division of pediatric surgery at tertiary-care hospital. PATIENTS: Data of 537 adolescents who underwent varicocelectomy were classified into two groups, depending on surgical approach. INTERVENTION: Open or laparoscopic varicocelectomy. MAIN OUTCOME MEASURES: Indications for surgery, complications, duration of surgery, hospital stay, and recurrences rate. RESULTS: The median age of the patients was 15 years. The median (IQR) duration of surgery was 12 (11,15.3) min in laparoscopic and 25 (10,30) min in open group (P<0.001). The most common complication was hydrocele (n=29), which was more common in open group (6.8% vs 1.4%; P=0.01). A total of 16 recurrences were recorded, all in open group (P=0.049). In both groups, sperm concentration (P<0.001), morphology (P<0.001) and motility (laparoscopy, P=0.001; P=0.02; open varicocelectomy, P=0.001; P=0.04) improved six months after surgery in patients with varicocele stage I and II. In stage III there was an improvement in sperm concentration (P=0.002; P=0.001) and morphology (P=0.03; P=0.06), while sperm motility (P=0.15; P=0.2) did not significantly recover in either of the groups. CONCLUSION: Laparoscopic and open varicocelectomy are equally effective and result in significant improvement of testicular volume, disappearance of pain, and sperm parameters in adolescents. Based on our findings laparoscopic varicocelectomy is associated with shorter operating time, shorter hospitalization, faster recovery, and fewer complications and recurrences.