Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews.
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ABSTRACT:
SUBMITTER: Blanchet C
PROVIDER: S-EPMC6406645 | biostudies-literature | 2019 Feb
REPOSITORIES: biostudies-literature
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Project description:PurposeTo systematically summarize evidence from multiple systematic reviews (SRs) examining interventions addressing medication nonadherence and to discern differences in effectiveness by intervention, patient, and study characteristics.SummaryMEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for papers published from January 2004 to February 2017. English-language SRs examining benefits of medication adherence interventions were eligible. Inclusion was limited to adult patients prescribed medication for 1 of the following disease conditions: diabetes and prediabetes, heart conditions, hypertension and prehypertension, stroke, and cognitive impairment. Non-disease-specific SRs that considered medication adherence interventions for older adults, adults with chronic illness, and adults with known medication adherence problems were also included. Two researchers independently screened titles, abstracts, and full-text articles. They then extracted key variables from eligible SRs, reconciling discrepancies via discussion. A MeaSurement Tool to Assess systematic Reviews (AMSTAR) was used to assess SRs; those with scores below 8 were excluded. Conclusions regarding intervention effectiveness were extracted. Grades of Recommendation, Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality.ResultsOf 390 SRs, 25 met the inclusion criteria and assessed adherence as a primary outcome. Intervention types most consistently found to be effective were dose simplification, patient education, electronic reminders to patients, and reduced patient cost sharing or incentives. Of 50 conclusions drawn by the SRs, the underlying evidence was low or very low quality for 45 SRs.ConclusionDespite an abundance of primary studies and despite only examining high-quality SRs, the vast majority of primary studies supporting SR authors' conclusions were of low or very low quality. Nonetheless, health system leaders seeking to improve medication adherence should prioritize interventions that have been studied and found to be effective at improving patient adherence, including dose simplification, education, reminders, and financial incentives.
| S-EPMC6946938 | biostudies-literature
Project description:BackgroundNon-adherence negatively affects the efficacy, safety and costs of therapies. Non-adherence is a multifactorial problem. This systematic review (SR) of SRs (overview) aims to identify factors that can influence the adherence of adult patients with chronic physical diseases.MethodsWe performed a systematic literature search in MEDLINE and Embase on June 13, 2018. We included SRs on the factors that can influence adherence in adult patients taking oral medications for treating physical chronic diseases. Two reviewers independently selected studies according to pre-defined inclusion criteria. Two reviewers independently assessed the risk of bias with the ROBIS tool. Data were extracted in standardized tables previously piloted by one reviewer and verified by a second reviewer. We synthesized data in tables in a structured narrative manner.ResultsWe included 21 SRs on eight different conditions. We rated eight SRs to be at low risk of bias and 13 to be at high risk of bias. Although higher education, employment, higher financial status and marriage/partnership mostly showed a positive effect on adherence, the impact was unclear because of the high uncertainty of the underlying evidence. The evidence indicates that socioeconomic status and social support might have a positive impact on adherence and that belonging to an ethnic minority might have a negative impact on adherence. Therapy-related factors (e.g., intake regime) and disease-related factors (e.g., duration) mostly showed no impact on adherence. Analysis of gender showed inconsistent results. Age might have a concave relation to adherence, i.e., adherence is lowest in very young and very old people. Depression has a negative impact on adherence. Impacts of other mental and physical comorbidities were uncertain. Co-payments (any or higher) have a negative impact on adherence. In contrast, the impacts of medication costs and insurance status were uncertain.ConclusionThis overview analyses factors that might impact adherence to oral therapies in adult patients with physical chronic diseases. Our overview suggests that there is a social gradient in adherence. However, for most factors, the evidence was not conclusive due to the risk of bias, inconsistency or imprecision.
| S-EPMC6511120 | biostudies-literature
Project description:BackgroundOxygen is routinely given to patients during and after surgery. Perioperative oxygen administration has been proposed as a potential strategy to prevent and treat hypoxaemia and reduce complications, such as surgical site infections, pulmonary complications and mortality. However, uncertainty exists as to which strategies in terms of amount, delivery devices and timing are clinically effective. The aim of this overview of systematic reviews and meta-analyses is to answer the research question, 'For which types of surgery, at which stages of care, in which sub-groups of patients and delivered under what conditions are different types of perioperative oxygen therapy clinically effective?'.MethodsWe will search key electronic databases (MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CENTRAL, Epistemonikos, PROSPERO, the INAHTA International HTA Database and DARE archives) for systematic reviews and randomised controlled trials comparing perioperative oxygen strategies. Each review will be mapped according to type of surgery, surgical pathway timepoints and clinical comparison. The highest quality reviews with the most comprehensive and up-to-date coverage of relevant literature will be chosen as anchoring reviews. Standardised data will be extracted from each chosen review, including definition of oxygen therapy, summaries of interventions and comparators, patient population, surgical characteristics and assessment of overall certainty of evidence. For clinical outcomes and adverse events, the overall pooled findings and results of subgroup and sensitivity analyses (where available) will be extracted. Trial-level data will be extracted for surgical site infections, mortality, and potential trial-level effect modifiers such as risk of bias, outcome definition and type of surgery to facilitate quantitative data analysis. This analysis will adopt a multiple indication review approach with panoramic meta-analysis using review-level data and meta-regression using trial-level data. An evidence map will be produced to summarise our findings and highlight any research gaps.DiscussionThere is a need to provide a panoramic overview of systematic reviews and meta-analyses describing peri-operative oxygen practice to both inform clinical practice and identify areas of ongoing uncertainty, where further research may be required. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021272361.
| S-EPMC9277880 | biostudies-literature
Project description:Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2-96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.
| S-EPMC6960703 | biostudies-literature
Project description:BackgroundNigella sativa (N. sativa) consumption has been associated with various health outcomes; however, the results are not completely consistent.ObjectivesThis overview of systematic reviews and meta-analyses aimed to evaluate the reporting and methodological quality, and to grade the available evidence of associations between N. sativa and health outcomes.MethodsPubMed, Cochrane Library, Embase, and Scopus databases were searched from their inception to September 30, 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement, Assessment of Multiple Systematic Reviews (AMSTAR) 2 checklist, and Grades of Recommendations, Assessment, Development and Evaluations (GRADE) systems were used to assess the reporting, methodological, and evidence quality for each meta-analysis, respectively. The results were synthesized in a narrative form.ResultsThis overview included 20 eligible meta-analyses published in peer-reviewed journals between 2013 and 2021. The overall methodological quality was relatively poor, with only one moderate quality, four low quality, and 15 critically low quality studies. For reporting quality, items two, five, eight, nine, 15, and 24 need to improve. Among the 110 outcome indicators of the quality of evidence, five were graded as moderate, 17 as low, and 88 as very low. Risk of bias, inconsistency, and imprecision were the main downgrading factors.ConclusionThis overview suggests that N. sativa is beneficial for various clinical outcomes. However, there are certain limitations to reporting and methodological quality. The clinical efficacy of N. sativa requires confirmation in high-quality, large-sample, randomized controlled trials.
| S-EPMC10086143 | biostudies-literature
Project description:PurposeTo evaluate and summarize published evidence from systematic reviews examining medication reconciliation.MethodsMEDLINE, the Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects were searched for English-language systematic reviews published from January 2004 to March 2019. Reviewers independently extracted information and scored review quality using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. For reviews with AMSTAR scores above 7, Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess evidence quality, with evidence summarized and conclusions compared across reviews.ResultsEleven reviews met the inclusion criteria, 5 of which used meta-analytic pooling. Most systematic reviews included primary studies of comprehensive bundled interventions that featured medication reconciliation as a central component. Reviews largely focused on transitions into and out of hospital settings. Five reviews focused exclusively on pharmacist-led interventions. Of the 5 reviews that considered all types of medication discrepancies, 3 reviews found very low-quality evidence that interventions reduced medication discrepancies. Neither of the 2 reviews that examined clinically significant medication discrepancies found any intervention effect. Of the 5 reviews that examined healthcare utilization outcomes, only 1 found any intervention effect, and that finding was based on low- to very low-quality evidence. Four reviews considered clinical outcomes, but none found any intervention effect.ConclusionAn overview of systematic reviews of medication reconciliation interventions found 9 high-quality systematic reviews. A minority of those reviews' conclusions were consistent with medication reconciliation alone having a measurable impact, and such conclusions were almost all based on very low-quality evidence.
| S-EPMC6885740 | biostudies-literature
Project description:BackgroundThere are no overviews of systematic reviews investigating haemoglobin thresholds for transfusion. This is important as the literature on transfusion thresholds has grown considerably in recent years. Our aim was to synthesise evidence from systematic reviews and meta-analyses of the effects of restrictive and liberal transfusion strategies on mortality.MethodsThis was a systematic review of systematic reviews (overview). We searched MEDLINE, Embase, Web of Science Core Collection, PubMed, Google Scholar, and the Joanna Briggs Institute EBP Database, from 2008 to 2018. We included systematic reviews and meta-analyses of randomised controlled trials comparing mortality in patients assigned to red cell transfusion strategies based on haemoglobin thresholds. Two independent reviewers extracted data and assessed methodological quality. We assessed the methodological quality of included reviews using AMSTAR 2 and the quality of evidence pooled using an algorithm to assign GRADE levels.ResultsWe included 19 systematic reviews reporting 33 meta-analyses of mortality outcomes from 53 unique randomised controlled trials. Of the 33 meta-analyses, one was graded as high quality, 15 were moderate, and 17 were low. Of the meta-analyses presenting high- to moderate-quality evidence, 12 (75.0%) reported no statistically significant difference in mortality between restrictive and liberal transfusion groups and four (25.0%) reported significantly lower mortality for patients assigned to a restrictive transfusion strategy. We found few systematic reviews addressed clinical differences between included studies: variation was observed in haemoglobin threshold concentrations, the absolute between group difference in haemoglobin threshold concentration, time to randomisation (resulting in transfusions administered prior to randomisation), and transfusion dosing regimens.ConclusionsMeta-analyses graded as high to moderate quality indicate that in most patient populations no difference in mortality exists between patients assigned to a restrictive or liberal transfusion strategy.Trial registrationPROSPERO CRD42019120503.
| S-EPMC7313211 | biostudies-literature
Project description:Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial. We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer. Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory. Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.
| S-EPMC4680970 | biostudies-literature
Project description:PURPOSE:The aim is to summarize and evaluate current systematic reviews and meta-analyses on MTHFR polymorphisms in recurrent pregnancy loss (RPL). METHODS:We searched Pubmed and Embase databases and selected in form of PICOS (participants, interventions, comparisons, outcomes, and study design). Our methodology was registered on PROSPERO (CRD42017042762). Systematic reviews and meta-analyses containing primary studies were extracted for meta-analyses, along with their OR and 95%CI. We assessed the quality of the included studies using AMSTAR and OQAQ criteria. RESULTS:Eleven systematic reviews and meta-analyses were identified. C677T was significantly related to RPL overall in Allele (OR, 95%CI 1.43, 1.29-1.60), Recessive (OR, 95%CI 1.66, 1.42-1.95), and Homozygous (OR, 95%CI 2.08, 1.66-2.61). There was no correlation observed between A1298C and RPL, except for in Heterozygous (OR, 95%CI 1.62, 1.17-2.25). CONCLUSIONS:We identified a difference in the association between MTHFR C677T polymorphism and RPL, especially in Asian population. No significant correlation was found between A1298C and RPL.
| S-EPMC6642244 | biostudies-literature
Project description:BackgroundSystematic reviews (SRs) and meta-analyses (MAs) for the use of acupuncture for cancer pain have been increasing, but the evidence has not been systematically and comprehensively assessed. We aimed to perform an overview of the evidence quality of SRs/MAs of acupuncture for improving cancer pain.Methods8 databases were systematically searched to identify SRs/MAs of acupuncture for improving cancer pain. The A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2), Risk of Bias in Systematic Reviews (ROBIS), Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and Grades of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively, were applied by 2 independent reviewers to evaluate the methodological quality, risk of bias, reporting quality, and evidence quality.ResultsA total of 14 SRs/MAs were included in the present study. By AMSTAR-2, two reviews were rated as having high methodological quality, while 12 were given a critically low rating. All SRs/MAs in Phase 1, Domain 1, and Domain 4, according to ROBIS, were at low risk. Furthermore, 4 reviews in Domain 2, twelve reviews in Domain 3, and ten SRs/MAs in Phase 3, were rated as having low risk of bias. With reporting quality, some reporting flaws were identified in the topic of protocol and registration, additional analyses, and search strategy. According to GRADE, the level of evidence quality was "critically low" to "moderate," and risk of bias was the most common downgraded factor.ConclusionAcupuncture may be beneficial in improving cancer pain. However, due to the identified limitations and inconsistent findings, we recommend further rigorous, and more standardized SRs/MAs to provide strong evidence for definitive conclusions.
| S-EPMC10637167 | biostudies-literature