国内护理领域系统评价/Meta分析的方法学与报告质量评价

目的评价国内护理领域系统评价/Meta分析方法学和报告质量,以期规范研究过程和报告方法。方法计算机检索CNKI,查找涉及护理领域的所有系统评价/Meta分析文献,检索时限从建库至2011年12月。由2位评价者独立筛查文献,并采用AMSTAR和PRISMA评价量表对纳入文献的方法学与报告质量进行评价并交叉核对,如遇分歧讨论解决。结果共纳入63篇文献,其中系统评价21篇,Meta分析42篇,分别发表在《护理研究》、《中华护理杂志》、《中国循证医学杂志》等13种期刊上。纳入文献中方法学质量存在的主要问题有:文献检索不够全面、对异质性产生的原因未进行综合分析和处理、未重视发表偏倚的识别。报告质量存在的主要问题表现在检索策略的报告不规范、纳入研究质量和偏倚风险报道不全面和研究结果表述不全(部分缺乏森林图、综合结果的估计值和可信区间、异质性检验结果)。结论目前国内护理领域系统评价/Meta分析的方法学质量及报告质量还存在不同程度的问题,尚需进一步提高方法学水平和规范报告质量。     

中文期刊发表的中医药系统评价/Meta分析现状调查

目的调查国内中文期刊发表的中医药系统评价/Meta分析文献的质量。方法电子检索1995年1月到2006年12月的CNKI和CBM,筛选中医药的系统评价、Meta分析全文,提取有关中医特色、治疗和对照干预措施的详细资料进行分析评价,并调查文献是否采用QUOROM声明报道结果。结果共纳入文献111篇,其中预防、不良反应、危险因素及先兆症各1篇,理化指标2篇,疗效及安全性评价106篇。涉及42个病种,报道脑血管疾病的文献41篇。干预措施为中医药者25篇,针灸者12篇。对照组:未设对照者2篇;未描述对照组干预措施者15篇;阳性药物对照50篇(其中西药26篇,中药12篇,中药 西药12篇);空白对照14篇;基础对照17篇;假针灸、穴位注射等4篇;安慰剂对照5篇;空白对照14篇及“互为对照”4篇。对照组和部分研究治疗组的干预措施种类均多。每篇文献纳入RCT1～35篇不等,其中24个研究纳入CCT。111篇文献在Cochrane协作网注册者仅14篇。有16篇未对纳入RCT进行质量评价,有22篇仅对纳入RCT进行简单不规范的评价。无一篇文献采用QUOROM声明报道结果。结论应重视提高中医药系统评价的质量。根据中医药特点,选题范围不宜过宽,药物选择不宜过多,注意中药的目标适应病证,应重视对干预措施的评价。系统评价应注意由临床工作者和方法学研究者共同完成,才能做出质量高又具中医特色的评价。     

Epidemiology, quality, and reporting characteristics of systematic reviews of acupuncture interventions published in chinese journals

Abstract Background: Systematic reviews (SRs) of acupuncture have become increasingly popular in China in recent years and have been published in large numbers. This review provides the first examination of epidemiological characteristics of these SRs as well as compliance with the PRISMA and AMSTAR guidelines. Objectives: The study objectives were to examine epidemiological and reporting characteristics as well as methodological quality of SRs of acupuncture published in Chinese journals. Methods: Four (4) Chinese databases were searched (CBM, CSJD, CJFD, and Wanfang Database) for SRs of Traditional Chinese Medicine, from January 1978 through to December 2010. Data were extracted into Excel spreadsheets. The PRISMA and AMSTAR checklists were used to assess reporting characteristics and methodological quality, respectively. Results: A total of 88 SRs were identified; none of the reviews had been updated. Less than one third (27.3%) were written by clinicians and one third (35.2%) were reported in specialty journals. The impact factor of 53.4% of the journals published was 0. Information retrieval was not comprehensive in more than half (59.1%) of the reviews. Less than half (36.4%) reported assessing for publication bias. Though 97.7% of the reviews used the term "systematic review" or "meta-analysis" in the title, no reviews reported a protocol and none were updated even after they had been published after 2 or more years. Conclusions: Although many SRs of acupuncture interventions have been published in Chinese journals, the reporting quality is troubling. Thus, the most urgent strategy is to focus on increasing the standard of SRs of acupuncture interventions, rather than continuing to publish them in great quantity.     

The quality of reports of critical care meta-analyses in the Cochrane Database of Systematic Reviews: an independent appraisal

OBJECTIVE: To independently appraise the methodological quality of a sample of reports of meta-analyses that address critical care topics in the Cochrane Database of Systematic Reviews compared with the quality of reports published in regular journals, using a validated assessment instrument, the Overview Quality Assessment Questionnaire (OQAQ). DATA SOURCE: Studies were selected from a search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1994 to 2003, using multiple search terms for critical care and sensitive filters to identify meta-analyses. STUDY SELECTION: Two authors independently selected meta-analyses that addressed topics pertinent to critical care medicine. DATA EXTRACTION: Two authors independently extracted the data. The proportion of reports that met each component of the OQAQ was determined, as was the overall quality score. Meta-analyses published in the Cochrane Database of Systematic Reviews were compared with those published in regular journals. DATA SYNTHESIS: There were 36 reports of meta-analyses in the Cochrane Database of Systematic Reviews and 103 reports of meta-analyses published in regular journals; 11 of these were reports of Cochrane reviews. The meta-analyses published in the Cochrane Database of Systematic Reviews were more likely to fulfill most components of the OQAQ. The median overall OQAQ scores indicated significant methodological problems in the reports regardless of the source of publication, although the reports in the Cochrane database scored higher than those in regular journals (five compared with two, p<.001). Major methodological flaws, notably failure to appropriately refer to the validity of included studies, were found in meta-analyses in both the Cochrane Database of Systematic Reviews and regular journals (44.4% and 79.3%, respectively). CONCLUSIONS: Although the quality of reports of meta-analyses published in the Cochrane Database of Systematic Reviews is superior to the quality of reports of meta-analyses published in regular journals, there is significant room for improvement. Clinicians should critically appraise all reports of meta-analyses before considering the results, regardless of the source of publication.     

脑胶质瘤干预类系统评价/Meta分析的方法学和报告质量评价

目的系统评价全世界脑胶质瘤干预类系统评价/Meta分析（SR/MA）的方法学和报告质量。方法计算机检索Pub Med、EMbase、h e Cochrane Library、CNKI、CBM等数据库,纳入脑胶质瘤干预类SR/MA,检索时限截至2013年7月。由2位研究者独立筛选文献,而后采用AMSTAR和PRISMA清单对纳入研究的方法学与报告质量进行评价与分析。结果共纳入51个SR/MA。结果显示：纳入研究中方法学质量存在的主要问题有无研究设计方案、检索策略不全面、纳入研究出版物形式局限、未评价文章发表偏倚及未说明相关利益冲突;纳入研究的报告质量存在的主要问题是检索策略的报告不规范、纳入研究质量和偏倚风险报道不全面和研究结果表述不全（部分缺乏森林图、综合结果的估计值和可信区间、异质性检验结果）。结论脑胶质瘤干预类SR/MA的方法学质量和报告质量还存在不同程度的问题,该领域研究者应提高SR/MA制作的科学性和规范性,并遵循PRISMA进行报告。     

国内医院药学人员系统评价/Meta分析文献发表与质量研究

目的通过对国内医院药学人员系统评价/Meta分析的发表状况及质量进行分析,了解并推进循证药学评价的发展和应用。方法计算机检索CBM、CNKI、WanFang Data、VIP、CMCI以及e Cochrane Library、EMbase和PubMed,查找国内医院药学人员公开发表的中英文系统评价和Meta分析,文献检索时间均从建库至2011年4月15日。由2位评价员分别按照纳入与排除标准选择文献、提取资料,并采用OQAQ量表和PRISMA量表对纳入研究方法学和报告质量进行评估,如遇分歧通过讨论或咨询第三方解决。采用SPSS 17.0软件进行数据统计与分析。结果共纳入中文文献216篇(包括西药及中药),英文文献15篇。统计分析结果显示,国内医院药学人员发表的系统评价/Meta分析自2008年起,每年文献量近于翻倍,文献来源地主要集中于北京、四川,分布于《中国药房》、《中国循证医学杂志》等62种杂志,涉及87家医院药学部门。中文文献总下载频次为14 346次,中文和外文文献总被引频次为154次。对纳入研究为RCT的220篇系统评价和Meta分析进行方法学和报告质量评估,结果显示:方法学质量评分最高6分,最低3分,平均4.28±0.56分;报告质量评分最高22.5分,最低9分,平均16.55±2.96分。结论我国医院循证药学评价在国内虽起步较晚,但发展迅速,为制定药物政策、临床用药指南和开展合理用药工作提供了大量证据,但其方法学和报告质量尚需进一步提高。     

中医药治疗绝经综合征的临床证据

目的总结国内外有关中医药治疗绝经综合征的系统评价/Meta分析证据,了解其疗效和安全性。方法以"更年期综合征、绝经综合征、围绝经期综合征"和"中医、中药、中医药"和"系统评价、Meta分析、循证医学"为检索词,检索Cochrane图书馆(2006年第4期)、MEDLINE(1991～2006)、OVID(1990～2006)、中国生物医学文献光盘(1990～2006)、中文科技期刊数据库(1989～2006)、中国学术期刊全文数据库(1979～2006)。查找有关中医药治疗绝经综合征的系统评价/Meta分析。结果外文数据库共检索到4篇,中文数据库共检索到2篇,均为中医药治疗绝经综合征的系统评价/Meta分析,对6篇文献进行归纳和总结。结论中医药治疗绝经综合征有一定的疗效,且安全性较高。但由于国外研究多为单味药研究,且研究数量偏少;国内研究的原始文献质量偏低等原因,降低了上述结论的可靠性,因此目前中医药对于绝经综合征的疗效及安全性的证据尚不够充分,尚需更严谨科学的试验以提供可靠性高的证据。     

国内公共卫生研究领域系统评价/Meta分析的质量评价

目的评价国内发表的公共卫生领域6种重要疾病防治的系统评价/Meta分析的方法学和发表质量。方法计算机检索中国期刊全文数据库、万方医药期刊数据库、维普中文科技期刊全文数据库及中国生物医学文献数据库,检索时间从建库至2010年6月,查找涉及肿瘤、脑血管疾病、心血管疾病、乙肝、结核病以及艾滋病等6种重要疾病防治的系统评价或Meta分析的中文文献,由两名研究人员独立筛查文献,并采用OQAQ和PRISMA评价量表对文献的方法学质量和发表质量进行评价,而后交叉核对,如遇分歧讨论解决。结果共纳入139篇文献,包括32篇系统评价,107篇Meta分析,文献方法学质量评分最高6.5分,最低1.5分,平均4.66±0.92分。无一篇文献符合全部9个条目的要求,主要存在资料检索不全面、资料的选择偏倚控制不足、对纳入的原始研究缺乏严格的质量评价等问题。报告质量评分平均为15.28±2.91分,其主要问题表现在摘要、资料收集及分析方法、偏倚控制及总结等方面报道不全面。结论目前国内公卫研究领域已发表的肿瘤、心脑血管疾病等6种重要疾病防治的系统评价/Meta分析的方法学质量及报告质量尚存在不同程度的问题,需要进一步提高方法学水平和规范发表。     

Epidemiology characteristics,reporting characteristics,and methodological quality of systematic reviews and meta‐analyses on traditional Chinese medicine nursing interventions published in Chinese journals

To evaluate the epidemiological characteristics, reporting characteristics, and methodological quality of systematic reviews in the traditional Chinese medicine nursing field published in Chinese journals. The number of systematic reviews in the traditional Chinese medicine nursing field has increased, but their epidemiology, quality, and reporting characteristics have not been assessed completely. We generated an overview of reviews using a narrative approach. Four Chinese databases were searched for systematic reviews from inception to December 2015. The Preferred Reporting Items of Systematic Reviews and Meta‐analyses and the Assessment of Multiple Systematic Reviews checklists were adopted to evaluate reporting and methodological quality, respectively. A total of 73 eligible systematic reviews, published from 2005 to 2015, were included. The deficiencies in reporting characteristics mainly lay in the lack of structured abstract or protocol, incomplete reporting of search strategies, study selection, and risk of bias. The deficiencies in methodological quality were reflected in the lack of a priori design and conflict of interest, incomplete literature searches, and assessment of publication bias. The quality of the evaluated reviews was unsatisfactory; attention should be paid to the improvement of reporting and methodological quality in the conduct of systematic reviews.     

The quality of reporting of randomized controlled trials of traditional Chinese medicine: a survey of 13 randomly selected journals from mainland China

BACKGROUND: The number of randomized controlled trials (RCTs) of traditional Chinese medicine (TCM) is increasing. However, there have been few systematic assessments of the quality of reporting of these trials. Objective: This study was undertaken to evaluate the quality of reporting of RCTs in TCM journals published in mainland China from 1999 to 2004. METHODS: Thirteen TCM journals were randomly selected by stratified sampling of the approximately 100 TCM journals published in mainland China. All issues of the selected journals published from 1999 to 2004 were hand-searched according to guidelines from the Cochrane Centre. All reviewers underwent training in the evaluation of RCTs at the Chinese Centre of Evidence-based Medicine. A comprehensive quality assessment of each RCT was completed using a modified version of the Consolidated Standards of Reporting Trials (CONSORT) checklist (total of 30 items) and the Jadad scale. Disagreements were resolved by consensus. RESULTS: Seven thousand four hundred twenty-two RCTs were identified. The proportion of published RCTs relative to all types of published clinical trials increased significantly over the period studied, from 18.6% in 1999 to 35.9% in 2004 (P < 0.001). The mean (SD) Jadad score was 1.03 (0.61) overall. One RCT had a Jadad score of 5 points; 14 had a score of 4 points; and 102 had a score of 3 points. The mean (SD) Jadad score was 0.85 (0.53) in 1999 (746 RCTs) and 1.20 (0.62) in 2004 (1634 RCTs). Across all trials, 39.4% of the items on the modified CONSORT checklist were reported, which was equivalent to 11.82 (5.78) of the 30 items. Some important methodologic components of RCTs were incompletely reported, such as sample-size calculation (reported in 1.1% of RCTs), randomization sequence (7.9%), allocation concealment (0.3 %), implementation of the random-allocation sequence (0%), and analysis of intention to treat (0%). CONCLUSION: The findings of this study indicate that the quality of reporting of RCTs of TCM has improved, but remains poor.     

《中国循证医学杂志》发表的干预类系统评价／Meta分析报告质量评价

目的评价《中国循证医学杂志》公开发表的干预类系统评价／Meta分析的报告质量,并分析其影响因素。方法对《中国循证医学杂志》从创刊至2011年底所发表的干预类系统评价／Meta分析进行检索。采用PRISMA清单评价和分析所有纳入文献,按照PRISMA清单各条目的符合程度由高到低分别评为“1分”、“0．5分”、“0分”。将所获数据录入Excle软件,并使用Meta—Analyst软件进行统计分析。结果共纳入干预类系统评价／Meta分析379篇,发表数量总体呈逐年上升之势。PRISMA清单平均评分19．97±3．15分（8．5-26分）。其中25篇（6．60％）评分为21—27分,认为报告相对完全;226篇（59．63％）评分为15～21分,认为报告存在缺陷;128篇（33．77％）评分为15分以下,认为有严重的信息缺失。分层分析结果显示：PRISMA的发布、有基金资助可以提高系统评价／Meta分析的报告质量（P〈0．05）;作者数≥3人、作者单位性质为大学和单位数≥2个有改善系统评价／Meta分析报告质量的趋势,但影响不具统计学意义（P〉0．05）。结论《中国循证医学杂志》所发表的干预类系统评价／Meta分析的报告质量有待提高,影响报告质量的主要因素有方案和注册、研究间偏倚、其他分析以及资金支持等,应加以重视。合理利用PRISMA将有助于提升系统评价／Meta分析的报告质量。     

Epidemiology,methodological and reporting characteristics of systematic reviews of nursing interventions published in China

The importance of systematic reviews (SRs) of nursing interventions' impact on practice makes their methodological quality and reporting characteristics especially important as it directly influence their utility for clinicians, patients and policy makers.The study aims to assess the methodological quality and reporting characteristics of SRs of nursing interventions in Chinese nursing journals. Three Chinese databases were searched for SRs of nursing interventions from inception to October 2011. The assessment of multiple systematic reviews (AMSTAR) and Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statements were used to assess methodological quality and reporting characteristics. Seventy‐four SRs were included. The proportion of SRs complying with AMSTAR checklist items ranged from 0% to 82.4%. No SRs reported an ‘a priori’ design or conflict of interest. Only four items were found to be reported in more than 50% of the SRs: a list of included and excluded studies, the scientific quality of included studies, the appropriate use of methods to combine findings, and formulating conclusions appropriately. The majority of SRs of nursing interventions in China had major methodological and reporting flaws that limited their value to guide decisions. Chinese authors and journals should adopt and keep up with the AMSTAR and PRISMA statements to improve the quality of SRs in this field.     

Grey literature in meta-analyses

BACKGROUND: In meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include "grey literature" in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it. OBJECTIVE: To examine evidence regarding whether grey literature should be included in meta-analyses and strategies to manage grey literature in quantitative synthesis. METHODS: This article reviews evidence on whether the results of studies published in peer-reviewed journals are representative of results from broader samplings of research on a topic as a rationale for inclusion of grey literature. Strategies to enhance access to grey literature are addressed. RESULTS: The most consistent and robust difference between published and grey literature is that published research is more likely to contain results that are statistically significant. Effect size estimates of published research are about one-third larger than those of unpublished studies. Unfunded and small sample studies are less likely to be published. Yet, importantly, methodological rigor does not differ between published and grey literature. CONCLUSIONS: Meta-analyses that exclude grey literature likely (a) over-represent studies with statistically significant findings, (b) inflate effect size estimates, and (c) provide less precise effect size estimates than meta-analyses including grey literature. Meta-analyses should include grey literature to fully reflect the existing evidential base and should assess the impact of methodological variations through moderator analysis.     

Development of the Documentation and Appraisal Review Tool for systematic reviews

AIM:To develop a tool to more explicitly assess and document the quality of systematic reviews.METHODS:We developed the Documentation and Appraisal Review Tool(DART)using epidemiologic principles of study design and the following resources:the modified Overview Quality Assessment Questionnaire(modified OQAQ),Assessment of Multiple Systematic Reviews(AMSTAR),the Cochrane Handbook,and the standards promoted by the Agency for Healthcare Research and Quality,and the Institutes of Medicine(IOM).We designed the DART tool to include the following:more detail to provide guidance and improve standardization of use,an approach to assess quality of systematic reviews addressing a variety of research designs,and additional space for recording notes to facilitate recall.DART underwent multiple rounds of testing with methodologists of varying levels of training and experience.Based on the results of six phases of pilot testing,we revised DART to improve performance,clarity and consistency.Pilot testing also included comparisons between DART,and the two most commonly used tools to evaluate the quality of systematic reviews,the modified OQAQ and AMSTAR.RESULTS:Compared to AMSTAR and modified OQAQ,DART includes two unique questions and several questions covered by modified OQAQ or AMSTAR but not both.Modified OQAQ and DART had the highest reporting consistency.Four AMSTAR questions were unclear and elicited inconsistent responses.Identifying reviewer rationale was most difficult using the modified OQAQ tool,and easiest using DART.DART allowsfor documentation of reviewer rationale,facilitating reconciliation between reviewers and documentation for future updates.DART also provides a comprehensive,systematic approach for reviewers with limited experience with systematic review methodology,to critically analyze systematic reviews.In addition,DART is the only one of the three tools to explicitly include quality review for biases specific to observational studies.This is now more widely recognized as important for assessing risk in order to generate recommendations that balance benefit to harm.The tool also includes the assessment of standards recommended by the March 2011 IOM Standards for Systematic Review.CONCLUSION:This comprehensive tool improves upon existing tools for assessing the quality of systematic reviews and guides reviewers through critically analyzing a systematic review.     

近5年中国科学引文数据库护理干预性系统评价/Meta分析报告质量分析

目的 评价近5年中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析的报告质量,以期规范其研究过程和报告方法,提升系统评价/Meta分析质量。方法 计算机检索CNKI、VIP、CBM和Wanfang数据库,搜集中国科学引文数据库收录的护理期刊发表的干预性系统评价/Meta分析研究,检索时限为2015年1月—2020年6月。由2名研究者独立筛选文献、提取资料,采用系统评价和Meta分析优先报告的条目进行报告质量评价;采用Office Excel 2019、Stata 15.0软件对相关数据进行统计和分析。结果 共纳入干预性系统评价/Meta分析176篇,其PRISMA评分为14.5~24.5分（20.17±2.00）,其中有1篇研究评分≤15分,有严重信息缺失;122篇评分为15~21分,存在一定报告缺陷;53篇评分为21~27分,报告相对完全。报告质量不足主要表现为结构式摘要（0/176）,方案和注册（0/176）,检索策略（55/176）,研究间偏倚（26/176）和资金支持（0/176）报告不全面。亚组分析结果显示：有基金资助、作者单位性质为医院和单位数为1个可明显提高系统评价/Meta分析报告质量（P<0.05）;作者人数对系统评价/Meta分析的报告质量影响不显著（P>0.05）。结论 目前,我国护理领域干预性系统评价/Meta分析的报告质量差异较大。因此,有必要采取相应的措施,加大对PRISMA的宣传和普及,推动其在护理期刊稿约中的引用;研究人员应严格遵守PRISMA相关条目,规范、详细地进行报告;护理期刊的编辑和审稿人在同行评审阶段也要严格遵循PRISMA的指导方针,以期提高系统评价/Meta分析的质量。     

Adherence to the PRISMA statement and its association with risk of bias in systematic reviews published in rehabilitation journals: A meta-research study

BackgroundSystematic reviews (SRs) and meta-analyses are essential resources for the clinicians. They allow to evaluate the strengths and the weaknesses of the evidence to support clinical decision-making if they are adequately reported. Little is known in the rehabilitation field about the completeness of reporting of SRs and its relationship with the risk of bias (ROB).ObjectivesPrimary: 1) To evaluate the completeness of reporting of systematic reviews (SRs) published in rehabilitation journals by evaluating their adherence to the PRISMA 2009 checklist, 2) To investigate the relationship between ROB and completeness of reporting. Secondary: To study the association between completeness of reporting and journals and study characteristics.MethodsA random sample of 200 SRs published between 2011 and 2020 in 68 rehabilitation journals was indexed under the “rehabilitation” category in the InCites database. Two independent reviewers evaluated adherence to the PRISMA checklist and assessed ROB using the ROBIS tool. Overall adherence and adherence to each PRISMA item and section were calculated. Regression analyses investigated the association between completeness of reporting, ROB, and other characteristics (impact factor, publication options, publication year, and study protocol registration).ResultsThe mean overall PRISMA adherence across the 200 studies considered was 61.4%. Regression analyses show that having a high overall ROB is a significant predictor of lower adherence (B=-7.1%; 95%CI -12.1, -2.0). Studies published in fourth quartile journals displayed a lower overall adherence (B= -7.2%; 95%CI -13.2, -1.3) than those published in first quartile journals; the overall adherence increased (B= 11.9%; 95%CI 5.9, 18.0) if the SR protocol was registered. No association between adherence, publication options, and publication year was found.ConclusionReporting completeness in rehabilitation SRs is suboptimal and is associated with ROB, impact factor, and study registration. Authors of SRs should improve adherence to the PRISMA guideline, and journal editors should implement strategies to optimize the completeness of reporting.     

Why meta-analyses are important for complementary and alternative medicine research

Complementary and alternative medicine (CAM) is defined as a group of interventions that are not generally considered part of conventional medicine. This definition already implies that CAM interventions are often not systematically studied; and the research evidence from single trials on CAM is often limited by small sample sizes, unclear methodology, and inadequate statistics. As a result, both, significant and insignificant results are often hard to interpret based on single trials. Summarizing the evidence from single CAM trials, qualitative systematic reviews still have to deal with the same problems as individual trials as they can only rely on the original reports. Thus, effects of CAM interventions are often underestimated or overestimated based on single trials or qualitative systematic reviews. While meta-analyses still are limited by the methodological shortcomings of the included studies, a well-conducted meta-analysis can deal with two common problems of CAM trials: inadequate statistics that rely on within-group comparisons and small underpowered sample sizes. Although large and high quality trials are urgently needed for most CAM interventions, funding often is limited. Until higher quality research is available, meta-analyses provide a useful tool to investigate the actual level of evidence of currently published CAM trials. This editorial presents examples of meta-analyses in the field of CAM and discusses how they contribute to the consolidation of evidence.     

Systematic analysis of hydroxyethyl starch (HES) reviews: proliferation of low-quality reviews overwhelms the results of well-performed meta-analyses

Purpose

Hydroxyethyl starch (HES) is a synthetic colloid used widely for resuscitation despite the availability of safer, less costly fluids. Numerous HES reviews have been published that may have influenced clinicians’ practice. We have therefore examined the relationship between the methodological quality of published HES reviews, authors’ potential conflicts of interest (pCOI) and the recommendations made.

Methods

Systematic analysis of reviews on HES use.

Results

Between 1975 and 2010, 165 reviews were published containing recommendations for or against HES use. From the 1990s onwards, favorable reviews increased from two to eight per year and HES’s share of the artificial colloid market tripled from 20 to 60?%. Only 7?% (12/165) of these reviews of HES use contained meta-analyses; these 7 % had higher Overview Quality Assessment Questionnaire (OQAQ) scores [median (range) 6.5 (3–7)] than reviews without meta-analysis [2 (1–4); p?p?Conclusions Low-quality HES reviews reached different conclusions than high-quality meta-analyses from independent entities, such as Cochrane Reviews. The majority of these low-quality positive HES reviews were written by a small group of authors, most of whom had or have since established ties to industry. The proliferation of positive HES reviews has been associated with increased utilization of an expensive therapy despite the lack of evidence for meaningful clinical benefit and increased risks. Clinicians need to be more informed that marketing efforts are potentially influencing scientific literature.     

Systematic reviews in laboratory medicine: principles, processes and practical considerations

BACKGROUND: Systematic reviews and meta-analyses are generally accepted to represent the highest level of evidence, and are a cornerstone in practising evidence-based medicine. So far, these efforts have been largely confined to the evaluation of the efficacy and effectiveness of therapeutic and preventive interventions. Systematic reviews in laboratory medicine are scarce and many of them do not meet essential quality criteria [Clin. Chem. Lab. Med. 38 (2000) 577]. Most of these problems are related to the poor design and heterogeneity of primary research, and that there are no agreed methods or quality standards for making systematic reviews in laboratory medicine. AIMS AND OBJECTIVES: For better evidence in laboratory medicine, not only higher quality primary studies but also standardized methodologies for designing, conducting and reporting systematic reviews in diagnostics are needed. The aim of this review is to present the general principles and provide a step-by-step process of systematic reviewing in laboratory medicine. METHODS: This narrative review is based on the overview of the medical literature on the methodology of systematic reviewing and that of the "state of the art" of evidence-based diagnosis. RESULTS: Systematic reviews of diagnostic interventions differ from that of therapeutic interventions in the methods of question formulation, the choice of study design, the assessment of study quality and the statistical methods used to combine results. Therefore, the general principles of systematic reviewing are adapted to the specialist field of laboratory medicine. The process of systematic reviewing consists of six key steps: (1) preparation for the review, (2) systematic search of the primary literature, (3) selection of papers for review, (4) critical appraisal of the selected literature, (5) analysis and synthesis of data, and (6) interpretation of data. The most important technical and methodological aspects of each step and the essential elements of a good systematic review in laboratory medicine are presented. CONCLUSIONS: Systematic reviews of diagnostic interventions support clinical and policy decisions, the development of practice guidelines, clinical audit, technology assessment, economic evaluations, education and training, and identify gaps in our knowledge for future research. Systematic reviewing of laboratory data is expected to result in better, bigger and more reliable primary studies, which hopefully will support the diffusion of new diagnostic technologies with scientifically proven efficacy and effectiveness in the future.