Evidence synthesis is the process of systematically gathering, analyzing, and integrating available research evidence. The quality of evidence synthesis depends on the quality of the original studies included. Validity assessment, also known as risk of bias assessment, is an essential method for assessing the quality of these original studies. Currently, there are numerous validity assessment tools available, but some of them lack a rigorous development process and evaluation. The application of inappropriate validity assessment tools to assessing the quality of the original studies during the evidence synthesis process may compromise the accuracy of study conclusions and mislead the clinical practice. To address this dilemma, the LATITUDES Network, a one-stop resource website for validity assessment tools, was established in September 2023, led by academics at the University of Bristol, U.K. This Network is dedicated to collecting, sorting and promoting validity assessment tools to improve the accuracy of original study validity assessments and increase the robustness and reliability of the results of evidence synthesis. This study introduces the background of the establishment of the LATITUDES Network, the included validity assessment tools, and the training resources for the use of validity assessment tools, in order to provide a reference for domestic scholars to learn more about the LATITUDES Network, to better use the appropriate validity assessment tools to conduct study quality assessments, and to provide references for the development of validity assessment tools.
Objective To systematically review the efficacy of six cognitive interventions on cognitive function of patients with mild cognitive impairment after stroke. Methods The PubMed, EMbase, Cochrane Library, SinoMed, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials on the effects of non-drug interventions on the cognitive function of patients with mild cognitive impairment after stroke from inception to March 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Network meta-analysis was then performed using Openbugs 3.2.3 and Stata 16.0 software. Results A total of 72 studies involving 4 962 patients were included. The results of network meta-analysis showed that the following five cognitive interventions improved the cognitive function of stroke patients with mild cognitive impairment: cognitive control intervention (SMD=−1.28, 95%CI −1.686 to −0.90, P<0.05) had the most significant effect on the improvement of cognitive function, followed by computer cognitive training (SMD=−1.02, 95%CI −1.51 to −0.53, P<0.05), virtual reality cognitive training (SMD=−1.20, 95%CI −1.78 to −0.62, P<0.05), non-invasive neural regulation (SMD=−1.09, 95%CI −1.58 to −0.60, P<0.05), and cognitive stimulation (SMD=−0.94, 95%CI −1.82 to −0.07, P<0.05). Conclusion Five cognitive interventions are effective in improving cognitive function for stroke patients with mild cognitive impairment, among which cognitive control intervention is the most effective. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Network meta-analyses (NMA) of survival data often rely on the proportional hazards (PH) assumption, however, this assumption fails when survival curves intersect. With the emergence of innovative therapies such as immunotherapy, the importance of NMA based on non-proportional hazards (non-PH) in the current evidence-based medicine evaluation of oncology drugs has become increasingly prominent. Fractional polynomial (FP) models do not rely on the assumption of PH, which can flexibly capture the characteristics of survival curves, and the corresponding fitting effects are better than those of the PH models. This study introduced a complete workflow in R for NMA using FP models with non-PH.
ObjectiveTo systematically review the efficacy of different nucleosides (acids) in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. MethodsThe Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of different nucleosides (acids) to prevent HBV reactivation after chemotherapy in cancer patients from inception to June 7th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Network meta-analysis was then performed by using Stata 16.0 software. ResultsA total of 43 RCTs involving 3 269 patients were included. There were 7 interventions, namely entecavir (ETV), lamivudine (LAM), adefovir dipivoxil (ADV), telbivudine (LdT), tenofovir dipivoxil (TDF), lamivudine combined with entecavir (LAM+ETV), and lamivudine combined with adefovir dipivoxil (LAM+ADV). The results of network meta-analysis showed that the efficacy of reducing the reactivation rate of ETV, LAM, ADV, LdT, TDF, LAM+ETV, LAM+ADV were superior than the control group. The ETV, LAM and ADV were not as effective as LAM+ETV. The leading drug combinations were LAM+ETV (94.8%), LdT (81.5%) and LA+ADV (58.0%). ConclusionsCurrent evidence shows that LAM+ETV, LdT, and LA+ADV are more effective in preventing hepatitis B virus reactivation after chemotherapy in cancer patients. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the efficacy of exercise therapy for patients with chronic low back pain (CLBP) by network meta-analysis (NMA).MethodsThe PubMed, EBSCO, EMbase, The Cochrane Library, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCT) on exercise for patients with CLBP from inception to May, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Then, NMA was performed by Stata 15.1 software.ResultsA total of 79 RCTs involving 5 782 CLBP patients were included. The effect of exercise therapy on pain in patients with CLBP were in the following rankings: yoga (SMD=−1.25, 95%CI −1.87 to −0.64, P<0.000 1), health Qigong/Taichi (SMD=−1.12, 95%CI −1.87 to −0.64, P=0.002), sling exercise (SMD=−1.07, 95%CI −1.64 to −0.50, P<0.000 1), Mackenzie therapy (SMD=−1.05, 95%CI −1.68 to −0.42, P=0.001), pilates (SMD=−0.96, 95%CI −1.74 to −1.78, P=0.016), multimodal training (SMD=−0.80, 95%CI −1.33 to −0.27, P=0.003) and stabilisation/motor control (SMD=−0.62, 95%CI −1.03 to −0.21, P=0.003). The effect of exercise therapy on function in patients with CLBP were in the following rankings: Mackenzie therapy (SMD=−0.62, 95%CI −1.03 to −0.21, P=0.003), and yoga (SMD=−0.88, 95%CI −1.51 to −0.25, P=0.007). Clusterank results showed that Mackenzie therapy, yoga, pilates, sling exercise and multimodal training were similar in improving pain and physical function in patients with CLBP.ConclusionsThe current study shows that yoga, Mackenzie therapy, pilates, sling exercise and multimodal training constitute the optimal group for improving CLBP symptoms. Health Qigong/Taichi is second only to yoga in improving pain in patients with CLBP, which has great promotional value.
ObjectiveTo systematically review the efficacy of five types of rehabilitation exercises, including Baduanjin, aquatic exercise, Taijiquan, somatosensory exercise and whole body vibration training for the intervention of motor function in stroke patients. MethodsWeb of Science, PubMed, EMbase, The Cochrane Library, CNKI, CBM, CSJD and WanFang Data databases were electronically searched to collect randomized controlled trials (RCTs) of rehabilitation exercise interventions for motor function in stroke patients from inception to October 2020. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, network meta-analysis was performed by using R and ADDIS software. ResultsA total of 50 RCTs involving 1 838 patients were included. The results of the meta-analysis showed that all five types of rehabilitation exercises were superior to conventional rehabilitation group in terms of balance in stroke patients (P<0.05), with the best ranking occupied by Baduanjin. In terms of lower limb strength, only the aquatic exercise was superior to conventional rehabilitation (P<0.05). In terms of walking function, somatic training and aquatic exercise were superior to conventional rehabilitation (P<0.05), with somatic exercises ranking first. ConclusionCurrent evidence shows that Baduanjin has an advantage in improving the balance, somatosensory interactive game exercise has an advantage in improving the walking capability and aquatic exercise has an advantage in improving the lower limb strength of stroke patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.
The biggest advantages of network meta-analysis (NMA) are to compare the effectiveness of different interventions about one conditions using a quantitative way, pool the results of direct comparison and indirect comparison, and rank the effectiveness based on outcomes, so as to select the best decision for patients. In the paper we introduce the methods of applying GRADE system to NMAs based on the papers published by GRADE working group and other relative studies. The steps of using GRADE to NMAs are mainly based on four aspects: firstly, presenting direct and indirect effect estimates and 95% CI; secondly, rating of quality of direct and indirect estimates; thirdly, presenting the results of NMAs; and the last step is to rating the quality of NMA effect estimates. The methods of rating the quality of direct comparison are the same to use GRADE in traditional meta-analysis. The rating of the quality of the indirect estimates is based on the ratings of the two pairwise estimates that contributes to the indirect estimate of the comparison of interest. The lower confidence rating of the two direct comparisons constitutes the confidence rating of the indirect comparison. When both direct and indirect evidence are available, we suggest using the higher of the two quality ratings as the quality rating for NMA estimate. The four steps of rating the quality of NMA from GRADE working group have promoted the theoretical system of NMA. But the process requires the evaluators to be familiar with GRADE system, and conduct pilot test to make sure the evaluators had understood the items of GRADE system correctly. In addition, we also need to concern that the non-transitivity among different groups and the inconsistency between direct comparison and indirect comparison.
Objective To systematically review the efficacy and safety of 3-month sustained releasing gonadotropin-releasing hormone agonist (GnRHa) (GnRHa 3M) and 1-month sustained releasing GnRHa (GnRHa 1M) in the treatment of pre-menopausal females with hormone receptor-positive breast cancer. Methods Databases including CNKI, WanFang Data, PubMed, EMbase and Web of Science were electronically searched to collect randomized controlled trials(RCTs) of GnRHa in the treatment of hormone receptor-positive breast cancer from inception to May 18th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. The gemtc software package in R 3.6.1 software and Stata 15.0 software were used for network meta-analysis. Results A total of 11 RCTs including 7 484 patients were included. The network meta-analysis results showed that there was no significant difference between GnRHa 3M and GnRHa 1M in E2 level (MD=−1.3, 95%CI −13 to 9.6), DFS (HR=1.2, 95%CI 0.88 to 1.7) and OS (HR=2.0, 95%CI 0.75 to 4.9). For safety, there was no significant difference between the two groups (RR=1.0, 95%CI 0.25 to 4.2). Conclusion Current evidence shows that the efficacy and safety of GnRHa 3M is similar to that of GnRHa 1M. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
With the rapidly growing literature across the surgical disciplines, there is a corresponding need to critically appraise and summarize the currently available evidence so they can be applied appropriately to patient care. The interpretation of systematic reviews is particularly challenging in cases where few robust clinical trials have been performed to address a particular question. However, risk of bias can be minimized and potentially useful conclusions can be drawn if strict review methodology is adhered to, including an exhaustive literature search, quality appraisal of primary studies, appropriate statistical methodology, assessment of confidence in estimates and risk of bias. Therefore, the following article aims to: (Ⅰ) summarize to the important features of a thorough and rigorous systematic review or meta-analysis for the surgical literature; (Ⅱ) highlight several underused statistical approaches which may yield further interesting insights compared to conventional pair-wise data synthesis techniques; and (Ⅲ) propose a guide for thorough analysis and presentation of results.
ObjectiveTo systematically review the efficacy of irbesartan combined with metoprolol plus conventional treatment compared with single drug (irbesartan, metoprolol) plus conventional treatment or conventional treatment for elderly patients with severe heart failure.MethodsPubMed, The Cochrane Library, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on irbesartan combined with metoprolol in the treatment of elderly patients with severe heart failure from January 2009 to September 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Network meta-analysis was then performed using gemtc package of R software.ResultsA total of 58 RCTs involving 5 064 patients were included. The results of meta-analysis showed that the efficiency, left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP) of combination group were significantly superior to single drug group.ConclusionsThe current evidence shows that under the premise of conventional treatment, the combination of irbesartan and metoprolol is more effective than irbesartan or metoprolol alone in the treatment of elderly patients with severe heart failure. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.