Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials

Introduction  Massage is a popular adjunct to cancer palliation. This systematic review is aimed at critically evaluating all available randomised clinical trials of massage in cancer palliation. Materials and methods  Six databases were searched to identify all trials of classical massage for cancer patients. Studies of other types of massage, e.g. reflexology, aromatherapy, were excluded. Fourteen trials met all inclusion criteria. Discussion  Collectively, they suggest that massage can alleviate a wide range of symptoms: pain, nausea, anxiety, depression, anger, stress and fatigue. However, the methodological quality of the included studies was poor, a fact that prevents definitive conclusions. Conclusion  The evidence is, therefore, encouraging but not compelling. The subject seems to warrant further investigations which avoid the limitations of previous studies.     

Effect of acupuncture in eczema: An overview of systematic reviews

BackgroundEczema is a common chronic relapsing inflammatory skin disease, which is characterized by intense itching. Acupuncture can be effective for eczema, and it is thus regarded as a common complementary treatment.ObjectiveThe intention of this overview is to methodically appraise and synthesize evidence about systematic reviews/meta-analyses (SRs/MAs) on acupuncture in eczema.MethodsWe searched for SRs/MAs of acupuncture with eczema in eight databases. We evaluated the methodological quality by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the reporting quality with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020 Checkist), and the evidence quality according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.ResultsA total of 7 SRs/MAs were included. According to AMSTAR-2, all the SRs/MAs included were categorized as critically low-quality. According to the PRISMA 2020 checklist, none of the reviews completed all the 27 items, thus their compliance was relatively weak. On the base of GRADE system, 2 of the 12 outcomes were rated as moderate, and 5 outcomes were rated as low-quality, while the others were regarded as very low-quality.ConclusionCompared with the control group, the included reviews of the acupuncture group were more effective and safer; however, the conclusion should be treated cautiously because the quality of evidence was not high enough to support it. In order to improve the quality, more rigorous, standardized, and comprehensive SRs/MAs need designing in the future.     

Transcendental meditation for lowering blood pressure: An overview of systematic reviews and meta-analyses

BackgroundTranscendental meditation (TM) is a stress reduction technique that can potentially lower blood pressure (BP) safely. The American Heart Association recommends that TM may be considered in clinical practice.ObjectiveTo provide an overview of all systematic reviews and meta-analyses of TM on BP for evidence-informed clinical decision making.MethodSystematic searches of PubMed, EBSCOhost, Cochrane Library, Web of Science, Embase, and PsycINFO for all systematic reviews and/or meta-analyses of randomized controlled trials (RCTs) with TM as an intervention, and outcome measures include systolic BP (SBP) and diastolic BP (DBP). Qualitative and quantitative data were synthesized. The methodological quality of the selected reviews was assessed using the AMSTAR checklist.ResultsEight systematic reviews and meta-analyses are included. Among them is an Agency for Healthcare Research and Quality report, a Cochrane systematic review, 4 independent reviews, and 2 reviews from a TM related institution. The quality of most of the included reviews is fair with a mean score of 5.75/11 on the AMSTAR scale. Overall, there exists a clear trend of increasing evidence over the years supporting the efficacy of TM in lowering BP. However, some conflicting findings remain across reviews and potential risk of bias exists in many of the RCTs included in these reviews.ConclusionPractising TM may potentially reduce the SBP by ∼4 mm Hg and DBP by ∼2 mm Hg. Such effect is comparable with other lifestyle interventions such as weight-loss diet and exercise. Further evidence from long-term well-designed RCTs conducted by independent researchers is needed.     

Interventions for the treatment of trachoma: An overview of Cochrane systematic reviews

Trachoma is an infectious disease caused by the bacterium Chlamydia trachomatis. Infection with C. trachomatis produces characteristic changes to the inner surface of the eyelids, resulting in sequela that when left untreated, leads to vision impairment and blindness. Repeated trachoma infections can cause severe scarring of the inside of the eyelid and can cause the eyelashes to scratch the cornea (trichiasis). The objective of this overview was to synthesize the evidence from Cochrane systematic reviews regarding the treatment of trachoma, and to provide a brief and user‐friendly front end for health professionals, researchers and policy makers. Face washing plus topical tetracycline eye ointment gave no additional protective benefit against active trachoma when compared with topical tetracycline eye ointment alone. Nor was any benefit conferred in the presence of severe trachoma. Primary health‐care education was found to be effective in reducing the odds of active trachoma. Evidence of benefit from insecticide spray or provision of latrines away from living areas was inconclusive for active trachoma. Surgical interventions that involve full‐thickness incision with tarsal rotation are more effective than alternate surgical procedures.     

中药治疗心房颤动的系统评价再评价

目的对中药治疗心房颤动的系统评价进行再评价。方法计算机检索PubMed、The Cochrane Library、EMbase、CNKI、CBM、WanFang Data和VIP数据库,搜集中药治疗心房颤动的系统评价(SR),检索时限均为建库至2019年7月。由2名研究员独立筛选和提取资料后,应用AMSTAR2量表、PRISMA声明和GRADE方法对纳入研究的方法学质量、报告质量和证据质量进行评价。结果最终纳入20个SR,其中15个合并分析了临床疗效,12个对不良反应进行了分析。纳入SR的AMSTAR2方法学质量评价整体偏低,评价为高质量的0篇,低质量1篇,极低质量19篇;得分较差的条目为条目2、7、8、9、10、12、13、14、16。纳入SR的PRISMA得分在14~22.5分之间,报告质量问题主要表现在方案与注册、资料条目、其他分析方法和资金来源方面。采用GRADE进行结局指标证据体评价,证据体质量普遍较低。结论中药治疗房颤可提高临床疗效,减少不良反应,但所纳入文献整体方法学质量不高,证据体质量普遍偏低,建议进一步开展高质量临床研究,为评价中药治疗房颤临床疗效提供依据。     

动态系统评价简介

系统评价作为循证医学中较高等级证据,其制作方法相对成熟,但更新机制尚不完善。动态系统评价通过周期性获取临床证据,及时更新系统评价结果,能有效提高系统评价的时效性。本文从动态系统评价的产生、特点、适用情况、实施过程、应用现状等几个方面对其进行简要介绍。     

Appraising the quality of guidelines for peripheral arterial catheters care: A systematic review of reviews

IntroductionCatheter-related bloodstream infections are among the most critical adverse events in critical patients with peripheral arterial catheters (ACs). Adherence to evidence-based guidelines can prevent and reduce arterial bloodstream infections.ObjectiveThe objectives of this study were to assess clinical practice guidelines for AC care and analyse methodological factors related to their development for effective dissemination and implementation in clinical practice.Review method usedThis was a systematic review of guidelines.Data sourcesWe searched PubMed, CINAHL, EMBASE, CNKI, and WANFANG databases from inception until September 2021 and evaluated websites of organisations that complied or produced guidelines.Review methodsA comprehensive list of guidelines for ACs care was included. We excluded incomplete guidelines, guidelines translated in other languages, duplicate publications, and summaries of multiple guidelines. Two reviewers independently extracted and collected the data, and three authors conducted quality assessments independently using the Appraisal of Guidelines for Research and Evaluation, Second Edition (AGREE II) tool. The intraclass correlation coefficient (two-way random) with a 95% confidence interval was used to evaluate the concordance between reviewers.ResultsOf the 738 total publications screened, seven were selected for evaluation. The concordance between observers was substantial (intraclass correlation coefficient >0.9, P < 0.001). Most guidelines (4/6) were developed in the United States and the United Kingdom. The median scores for the six domains were 89.0%, 65.5%, 58.0%, 86.0%, 65.0%, and 86.0%. The domains of stakeholder involvement, rigour of development, and applicability had the lowest scores. Guidelines by the United Kingdom's National Institute for Health and Care Excellence showed the highest quality.ConclusionsThe guidelines we included scored poorly on crucial domains (rigour of development, applicability, and stakeholder involvement). Most of the current recommendations on ACs were included in the guidelines for vascular catheter–related bloodstream infections. Therefore, targeted guidelines created specifically for ACs are warranted to reduce the incidence of catheter-related complications and ensure patient safety.     

Evidence on yoga for health: A bibliometric analysis of systematic reviews

ObjectiveTo support the research agenda in yoga for health by comprehensively identifying systematic reviews of yoga for health outcomes and conducting a bibliometric analysis to describe their publication characteristics and topic coverage.MethodsWe searched 7 databases (MEDLINE/PubMed, Embase, PsycINFO, CINAHL, AMED, the Cochrane Database of Systematic Reviews, and PROSPERO) from their inception to November 2019 and 1 database (INDMED) from inception to January 2017. Two authors independently screened each record for inclusion and one author extracted publication characteristics and topics of included reviews.ResultsWe retrieved 2710 records and included 322 systematic reviews. 157 reviews were exclusively on yoga, and 165 were on yoga as one of a larger class of interventions (e.g., exercise). Most reviews were published in 2012 or later (260/322; 81 %). First/corresponding authors were from 32 different countries; three-quarters were from the USA, Germany, China, Australia, the UK or Canada (240/322; 75 %). Reviews were most frequently published in speciality journals (161/322; 50 %) complementary medicine journals (66/322; 20 %) or systematic review journals (59/322; 18 %). Almost all were present in MEDLINE (296/322; 92 %). Reviews were most often funded by government or non-profits (134/322; 42 %), unfunded (74/322; 23 %), or not explicit about funding (111/322; 34 %). Common health topics were psychiatric/cognitive (n = 56), cancer (n = 39) and musculoskeletal conditions (n = 36). Multiple reviews covered similar topics, particularly depression/anxiety (n = 18), breast cancer (n = 21), and low back pain (n = 16).ConclusionsFurther research should explore the overall quality of reporting and conduct of systematic reviews of yoga, the direction and certainty of specific conclusions, and duplication or gaps in review coverage of topics.     

Communication training for health professionals who care for patients with cancer: a systematic review of effectiveness

Background Effective communication is increasingly recognised as a core clinical skill. However, there is evidence that health and social care professionals still lack basic communication skills.Purpose To assess the effectiveness of different communication skills training courses for health professionals in cancer care.Methods We searched six computerised databases and augmented this with a follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and results were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training in the area of cancer care were identified. Sixteen papers were included describing 13 interventions. Four were randomised controlled trials (RCTs) (grade I), with samples ranging from 72 to 233 subjects. The others were all grade III. Eleven interventions trained health professionals, two trained medical students. The outcomes measured included communication skills as assessed on audio or video, professionals self-report and patient assessment. All the interventions demonstrated modest improvements (effect sizes ranged 0.15–2) and one found deterioration in the outcomes measured.Conclusion Communication training improves basic communication skills. Positive attitudes and beliefs are needed to maintain skills over time in clinical practice and to effectively handle emotional situations.     

Complementary and alternative medicine for lowering blood lipid levels: A systematic review of systematic reviews

BackgroundThe aim of this article is to summarize and critically evaluate the evidence from systematic reviews (SRs) of complementary and alternative medicine (CAM) for lowering blood lipid levels (BLL).MethodsEight electronic databases were searched until March 2016. Additionally, all the retrieved references were inspected manually for further relevant papers. Systematic reviews were considered eligible, if they included patients of any age and/or gender with elevated blood lipid levels using any type of CAM. We used the Oxman and AMSTAR criteria to critically appraise the methodological quality of the included SRs.ResultsTwenty-seven SRs were included in the analyses. The majority of the SRs were of high methodological quality (mean Oxman score = 4.81, SD = 4.88; and the mean AMSTAR score = 7.22, SD = 3.38). The majority of SRs (56%) arrived at equivocal conclusions (of these 8 were of high quality); 7 SRs (37%) arrived at positive conclusions (of these 6 were of high quality), and 2 (7%) arrived at negative conclusions (both were of high quality). There was conflicting evidence regarding the effectiveness of garlic; and promising evidence for yoga.ConclusionsTo conclude, the evidence from SRs evaluating the effectiveness of CAM in lowering BLL is predominantly equivocal and confusing. Several limitations exist, such as variety of doses and preparations, confounding effects of diets and lifestyle factors, or heterogeneity of the primary trials among others.     

Communication training for health professionals who care for patients with cancer: a systematic review of training methods

Background Effective communication is increasingly recognised as a core clinical skill. Many health and social care professionals, however, do not feel adequately trained in communicating and in handling interpersonal issues that arise in the care of patients with cancer.Aim The aim of this paper was to assess the effectiveness of different training methods used in communication training courses for health professionals.Method We searched six computerised databases and augmented this with follow-up of references and grey (unpublished) literature. We included all studies evaluating communication training and assessed methodological quality according to the standard grading system of the Clinical Outcomes Group. Data on author, year, setting, objectives, study design and training methods were extracted and compared in tabular format.Results A total of 47 studies potentially assessing communication training were identified. Sixteen papers were included evaluating 13 interventions. Four were randomised controlled trials (RCTs) (grade a); the others were grade III. Eleven interventions trained health professionals; two trained medical students. Interventions for training in communication skills were characterised by the variety of communication approaches used and a diversity of methods. They were applied to health professionals with very different roles, served different purposes and evaluated a variety of outcome measures: behavioural assessments, patient outcomes and professionals self-report.Conclusions The best results are to be expected from a training programme that is carried out over a longer period of time. Learner-centred programmes using several methods combining a didactic component focusing on theoretical knowledge with practical rehearsal and constructive feedback from peers and skilled facilitators proved to be very effective. Small groups encouraged more intensive participation. Training in communication for both medical or nursing students and senior health professionals is advisable.     

Acupuncture for treatment of insomnia: An overview of systematic reviews

PurposeTo evaluate the reliability of the methodological quality and outcome measures of systematic review (SR) /meta-analysis (MA) of acupuncture for insomnia.MethodsWe conducted a comprehensive literature search for SRs with MAs in seven international and Chinese databases. Two reviewers independently extracted data and assessed the methodological quality of the reviews according to the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the quality of evidence.ResultsThirty-four reviews were included. The AMSTAR-2 score showed that most of the included studies were of low methodological quality and included only two high-quality literatures. The lowest score were the item 10 (all the studies didn't report on the sources of funding for the studies included in the review), item 7(32 studies didn't provide a list of excluded studies and justify the exclusions) and item 3 (27 studies didn't explain their selection of the study designs for inclusion in the review).ConclusionMost of the reviews included suggested that the acupuncture group was more effective than the control group in the treatment of insomnia, but the methodological quality of most of the studies and the quality of evidence were low.     

Guidelines on the management of fibromyalgia syndrome – A systematic review

We compared the methodology and the recommendations of evidence‐based guidelines for the management of fibromyalgia syndrome (FMS) to give an orientation within the continuously growing number of reviews on the therapy of FMS. Systematic searches up to April 2008 of the US‐American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, the Association of the Scientific Medical Societies in Germany (AWMF) and Medline were conducted. Three evidence‐based guidelines for the management of FMS published by professional organizations were identified: The American Pain Society (APS) (2005), the European League Against Rheumatism (EULAR) (2007), and the AWMF (2008). The steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of FMS and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. APS and AWMF ascribed the highest level of evidence to systematic reviews and meta‐analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. Both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive‐behavioral therapy, amitriptyline, and multicomponent treatment. In contrast, EULAR assigned the highest level of recommendation to a set of to pharmacological treatment. Although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels.     

Duplicates in systematic reviews: A critical,but often neglected issue

The number of systematic reviews is gradually increasing over time. Also, the methods to perform a systematic review are being improved. However, little attention has been paid for the issue regarding how to find duplicates in systematic reviews. On the basis of the survey and systematic reviews by our team and others, we review the prevalence, significance and classification of duplicates and the method to find duplicates in a systematic review. Notably, although a preliminary method to find duplicates is established, its usefulness and convenience need to be further confirmed.     

Comparing midwife-led and doctor-led maternity care: a systematic review of reviews

sutcliffe k., caird j., kavanagh j., rees r., oliver k., dickson k., woodman j., barnett-paIge e. & thomas j. (2012)?Comparing midwife-led and doctor-led maternity care: a systematic review of reviews. Journal of Advanced Nursing68(11), 2376-2386. ABSTRACT: Aims. A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians. Background. A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed. Data sources. Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed. Review methods. A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion. Results. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. Conclusions. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.     

Non-pharmacological interventions for spasticity in adults: An overview of systematic reviews

ObjectivesSpasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes.MethodsData sources: a literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15th June 2017. Data extraction and synthesis: two reviewers applied inclusion criteria to select potential systematic reviews, independently extracted data for methodological quality using Assessment of Multiple Systematic Reviews (AMSTAR). Quality of evidence was critically appraised with Grades of Recommendation, Assessment, Development and Evaluation (GRADE).ResultsOverall 18 systematic reviews were evaluated for evidence for a range of non-pharmacological interventions currently used in managing spasticity in various neurological conditions. There is “moderate” evidence for electro-neuromuscular stimulation and acupuncture as an adjunct therapy to conventional routine care (pharmacological and rehabilitation) in persons following stroke. “Low” quality evidence for rehabilitation programs targeting spasticity (such as induced movement therapy, stretching, dynamic elbow-splinting, occupational therapy) in stroke and other neurological conditions; extracorporeal shock-wave therapy in brain injury; transcranial direct current stimulation in stroke; transcranial magnetic stimulation and transcutaneous electrical nerve stimulation for other neurological conditions; physical activity programs and repetitive magnetic stimulation in persons with MS, vibration therapy for SCI and stretching for other neurological condition. For other interventions, evidence was inconclusive.ConclusionsDespite the available range of non-pharmacological interventions for spasticity, there is lack of high-quality evidence for many modalities. Further research is needed to judge the effect with appropriate study designs, timing and intensity of modalities, and associate costs of these interventions.