ObjectiveTo evaluate the efficacy of western conventional treatment based on traditional Chinese medicine retention enema on patients with hepatic encephalopathy. MethodsSuch databases as the Cochrane Library, PubMed, EMbase, VIP, CNKI, CBM and WanFang Database were searched from the inception to November 2013 to collect randomized controlled trials (RCTs) about Western conventional treatment based on traditional Chinese medicine retention enema to treat hepatic encephalopathy, and the references of the included literature were also retrieved. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated and cross-checked the methodological quality. Then meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 26 RCTs involving 1 691 patients were included. The subgroup analyses based on the length of intervention time showed that when the course of treatment intervention was less than one, the overall effective rate of the Chinese herbal retention enema group was higher than that of the control group, with a significant difference[RR=1.34, 95%CI (1.25, 1.44), P<0.000 01]; after more than one course of treatment intervention, the overall effective rate of the Chinese herbal retention enema group was higher than that of the control group, with a significant difference[RR=1.34, 95%CI (1.21, 1.48), P<0.000 01]. ConclusionOn the basis of available evidence, the western medicine treatment based on traditional Chinese medicine retention enema for hepatic encephalopathy has a certain effect. However, the heterogeneity among the included studies is large. It is necessary to design multicenter, strictly randomized and double-blind test controlled trials with large samples to validate these conclusions and to further confirm the clinical curative effect.
ObjectiveTo systematically review the efficacy of Chinese herbal enema in ileus patients. MethodsThe randomized controlled trials (RCTs) and quasi-RCTs about Chinese herbal enema and gastrointestinal intubation versus western medicines in the treatment of ileus disease was searched in PubMed, Web of Science, EMbase, The Cochrane Library (Issue 4, 2013), CBM, CNKI, VIP and WanFang Data from the date of their establishment to July 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.1. ResultsA total of 27 RCTs and 3 quasi-RCTs involving 3 074 patients were included. The results of meta-analysis showed that the Chinese herbal enema and gastrointestinal intubation group was superior to the control group in raising the total clinical effective rate (OR=4.69, 95%CI 3.70 to 5.94, P < 0.000 01), as well as shortening the hospitalization time (SMD=-1.19, 95%CI-1.42 to-0.96, P < 0.000 01), time of anus exhaust (SMD=-1.52, 95%CI-1.76 to-1.28, P < 0.000 01), defecation (SMD=-2.27, 95%CI-3.43 to-1.11, P=0.000 1), time of gastric tube indwelling (SMD=-1.56, 95%CI-1.86 to-1.27, P < 0.000 01), and symptoms complete resolution (SMD=-0.74, 95%CI-1.11 to-0.37, P < 0.000 1), all with significant differences. ConclusionChinese herbal enema and gastrointestinal intubation is more beneficial than western medicine alone for ileus. Due to limited quality of the included studies, the abovementioned conclusion still needs to be verified by conducting more high quality blinding RCTs.
ObjectiveTo systematically review the effect of early moxibustion therapy on the recovery of gastrointestinal functioning after gastrointestinal surgery. MethodsWe searched The Cochrane Library, Web of Science, PubMed, EMbase, Ovid, EBSCO, CBM, CNKI, VIP and WanFang Data from inception to Jan. 2015, to collect randomized controlled trials (RCTs) and quasi-RCTs about early moxibustion therapy on the recovery of gastrointestinal functioning. Two reviewer independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 and Stata 12.0 softwares. ResultsA total of nine RCTs and four quasi-RCTs involving 1444 patients were included. The results of meta-analysis indicated that, the early moxibustion therapy group was significantly superior to the control group in total effective rate (OR=1.26, 95%CI 1.17 to 1.36, P<0.00001), the time to first bowel motion (MD=-11.79, 95%CI -13.79 to -9.78, P<0.00001), the time to first flatus (MD=-15.13, 95%CI -17.40 to -12.85, P<0.00001) and the time to first passage of feces (MD=-34.93, 95%CI -59.33 to -10.53, P=0.005). ConclusionCurrent evidence shows that early moxibustion therapy after gastrointestinal surgery is beneficial for promoting the recovery of gastrointestinal functioning. In addition, due to the low methodological quality of included studies, larger sample, high-quality RCTs are needed to prove the above conclusion.
ObjectiveTo assess the efficacy and safety of Tiao-She nursing of traditional Chinese medicine (TCM) for mild cognitive disorder (MCD), and to provide theoretical basis for developing evidence-based guideline of Tiao-She nursing of TCM. MethodsWe searched PubMed, Web of Science, The Cochrane Library, EMbase, MEDLINE, Springerlink, CBM, CNKI, VIP and WanFang Data for systematic reviews/meta-analyses (SRs/MAs), as well as randomized controlled trials (RCTs), up to December 2014. Two reviewers screened literature according to the inclusion and exclusion criteria and extracted data. Methodological quality and evidence quality of included SRs/MAs were assessed using AMSTAR scale and GRADE tool, respectively. Methodological quality of included RCTs was assessed using risk of bias assessment tool of the Cochrane Handbook 5.1.0. ResultsNine RCTs were identified, but no SRs/MAs was retrieved. Interventions for MCD included acupoint massage, moxibustion, auricular-plaster therapy, qigong, Tai chi, calligraphy, and food therapy of ginseng. All included RCTs showed that Tiao-She nursing of TCM was effective on cognitive ability and psychosocial function. ConclusionTiao-She nursing of TCM might be effective and safe, and the methods are variable. Due to the limitation of the quality of included RCTs, the efficacy and safety of Tiao-She nursing of TCM for MCD are still needed to be verified by high quality studies.
The metacor, which is developed based on the classical frequentist theory, is a specified package for performing meta-analysis of correlation coefficients in R software. This package was officially launched in 2011. Based on the DerSimonian-Laird method and Olkin-Pratt method, correlation coefficients can be directly pooled by using this package. The metacor package also can be used to draw the forest plot and is easy to use; however, it still needs to be improved. This paper briefly introduced how to perform a meta-analysis of correlation coefficients using the metacor package in R software through an example.
Meta-analysis has been regarded as the critical tool of assisting the healthcare professionals to make decisions. And the theory of evidence-based medicine is widely disseminated in domestic. However, it must be noted that the increasing number of meta-analyses causes a fact that several meta-analyses investigating the same or similar clinical questions were captured commonly. More importantly, the results from these meta-analyses are often conflicting. Consequently, decision-making of those healthcare professionals who depend on those results become a thorny thing. To address this issue, Jadad et al. from McMaster University proposed an adjunct algorithm to help healthcare professionals to select the best result from conflicting meta-analyses to make decisions properly. Our article will introduce the tool briefly and explain the process of it with an example.
Cumulative meta-analysis could help researchers to justify the effectiveness of the intervention and whether the obtained evidence is sufficient. However, the process of the meta-analysis does not adjust the repeated testing of the null hypothesis and neither quantifies the statistical power. The sequential meta-analysis has solved the aforementioned problems and has been widely used in the clinical practice and decision-making. Currently several methods of sequential meta-analysis have been proposed and these methods differ from each other. Of which, the methodology of trial sequential (TSA) is well developed and corresponding performance is relatively easy; the methodology of double-triangular test of Whitehead is lagged than TSA and its performance is relatively difficult; the approach of semi-Bayes refers to the theory of Bayes and it's very difficult to generalize. Our paper aimed to give a brief introduction of the methodology of the sequential meta-analysis.
Joanna Briggs Institute (JBI) is an international collaboration center for evidence-based healthcare, which mainly focuse on evidence-based activities in nursing science, rehabilitation science and psychiatry science. The present article systematically and comprehensively introduces the foundation, development, mission, organizational structure, and the major contents of the JBI institute, so as to provide theory support for Chinese researchers who specialize in studying methods and practice in these given fields.
Qualitative research can provide interpretations of patients on experience, attitudes, beliefs and psychological changes of disease nursing, so it reflects the scientificity, humanity and ethicality of nursing science. How to assess and integrate findings derived from qualitative researches and use them in decision making is a key issue for researchers. This paper introduced how to evaluate the methodological quality and reporting quality of qualitative research, perform qualitative systematic review and meta-synthesis, and evaluate the quality of evidence of meta-syntheses using the ConQual tool.
To meet the evidence users' requirement for qualitative systematic review, it is necessary to establish an evidence classification system for it. The Confidence of the Evidence from Reviews of Qualitative research (CERQual) approach was developed for evidence classification of qualitative systematic review. Four components contribute to the assessment in CERQual: (1) Methodological limitations: Refer to problems in the design or conduct of the primary studies which need to be evaluated by specific tools used for methodological assessment of qualitative research. (2) Relevance: Relevance is the extent to which the objective, population etc. of included studies are applicable to the review question. (3) Coherence: It is the extent to which the review finding is consistent with the results in primary studies or the patterns, differences across primary studies, were explained reasonably. (4) Adequacy of data: Refer to the degree of richness and quantity of data supporting a review finding. Finally, integrate each of the components and rate the confidence of individual review finding as high, moderate, low or very low confidence. CERQual provides a transparent method for assessing the confidence of evidence from reviews of qualitative research. It may facilitate the use of qualitative research in evidence-informed decision making and guideline development processes. This article will introduce CERQual approach in detail and give an example to explain how to use it.