The valid results of Meta-analysis on biomedical data, will have an important value to clinical practice and health policy making. To review the validity of meta-analysis results, one should consider the following issues: The coverage ratio of included studies, quality of data, publication bias and its effect, heterogeneity, the correct selection of statistical methods as well as clinical significance and external validity of overall effect size. The results of Meta-analysis will keep on updating as new related studies are located and included.
Objective To explore and appraise the representation of samples in clinical trials of hypertension medications. Methods Four databases (MEDLINE, CBM, CNKI and VIP )were searched systematically. All RCTs of hypertension medication run in China from January 1996 to December 2006 were collected, and then appraised by a quality assessment checklist. Those RCTs with 3 or more grading score were enrolled for critical appraisal of representation of samples. Results A total of 164 RCTs on hypertension were targeted and reviewed systematically. 122 (74.4%) RCTs selected secondary or tertiary cares as their trial settings. 81 (49.4%) RCTs described the source of samples, in which 86.3% were hospitalized patients. 16.7% patients in 12 (7.3%) RCTs were excluded in run-in periods, 24.6% patients were ineligible for inclusion criteria in 8 (4.9%) RCTs. 8.4% eligible patients were non-enrolled in 3 RCTs. 89.4% subjects were mild to moderate essential hypertension. The proportions of women and the patients aged 65 years or older were 41.1% and 16.9%, respectively, and were markedly lower than that in community (Plt;0.001). Conclusion Representation of samples in clinical trials of hypertension medications was not good and the influencing factors of representation were not reported sufficiently. These would undermine the efforts to provide evidence-based care to all hypertensive patients.
Objective To evaluate long-term effectiveness of recombinant human growth hormone (rhGH) for children with idiopathic short stature (ISS). Methods The randomized controlled trials (RCTs) about rhGH in treating ISS published from 1985 to 2010 were searched in PubMed, ScienceDirect, EBSCOHost, EMbase, The Cochrane Library, CBM, CNKI and VIP. According to the Cochrane Handbook, two reviewers independently screened literature, extracted data, assessed methodological quality, and conducted meta-analysis using RevMan 5.0 software. Results A total of 11 RCTs involving 607 ISS children were included. The results of meta-analysis showed that, compared with the blank/placebo control group after 1-year treatment, the rhGH group resulted in a significant increase in height standard deviation score (SDS) (MD=0.29, 95%CI 0.03 to 0.54, P=0.03), growth velocity (MD=2.68 cm/year, 95%CI 1.70 to 3.65, Plt;0.000 01), and adult SDS (MD=0.46, 95%CI 0.29 to 0.63, Plt;0.000 01). Conclusion rhGH can effectively promote the growth of ISS children. But due to the limitation of quality and small sample size of the included studies, its effectiveness still needs to be further proved by more high quality RCTs.
Types of publication bias and its background are introduced in this paper, and publication bias can be investigated and deal with three methods: funnel plot, trim and filling method, and formula method. Those methods can be used to detect publication bias in conducting systematic reviews.
Objective To analyze the heterogeneity of systematic reviews (SRs)/Meta-analysis on traditional Chinese medicine (TCM), and explore strategies for addressing heterogeneity correctly during the process of conducting TCM related to systematic reviews (SRs). Methods Both electronic and hand searches were used to identify TCM SRs in CBM, CNKI, VIP database, and Chinese Journal of Evidence-Based Medicine. Two researchers performed data extracting and heterogeneity evaluation independently. Results A total of 115 TCM SRs were included, involving 17 types of diseases, among which the cardiovascular and cerebrovascular diseases were the most addressed (n=36, 31.30%). There were 35.65% (n=41) of SRs which integrated two or more types of studies; interventions of the included studies were inconsistent in 53.91% (n=62) of TCM SRs; control groups of the included studies were completely different in 60 (52.17%) SRs; and 8.7% (n=10) of SRs failed to investigate heterogeneity in the process of synthesis analysis. Conclusion The heterogeneity is common in TCM related to SRs, and the most addressed is clinical heterogeneity. Addressing heterogeneity incorrectly would downgrade the quality of TCM related to SRs.
Objective To verify the applicability of AGREE-China and select high-quality clinical practice guidelines (CPGs) or consensus for the management of fragility fractures (FF) in China by evaluating their methodological quality. Methods CBM, CNKI, WanFang Data, VIP databases and related CPGs websites were electronically searched. Two reviewers independently screened literature, extracted data, and checked each other. Quality appraisal of CPGs or consensus were evaluated by AGREE Ⅱ and AGREE-China, and weighted Kappa value and intraclass correlation coefficients (ICC) were calculated to illustrate the consistency of the two tools. Results Nine CPGs and sixteen consensuses were included. Among the six domains in AGREE Ⅱ, "scope and purpose" domain (62.22%) scored higher than "clarity of presentation" domain (45.67%). The "stakeholder involvement" domain (34.89%) and "applicability" domain (38.17%) both exceeded 30%, while "rigor of development" domain (18.79%) and "editorial independence" domain (13.33%) were lower. Among the five domains in AGREE-China, "conflict of interest" domain (72.80%) was higher, followed by "usability/feasibility" domain (49.87%), while "scientificity/preciseness" domain (20.36%), "effectiveness/safety" domain (25.20%) and "economic efficiency" domain (14.40%) were lower. The weighted Kappa value of recommendations from the two tools was 0.694 (P<0.001), showing moderate consistency. ICC values of the same items and two evaluators were all greater than 0.85 (P<0.001) with high consistency. Three high-quality CPGs were consistently selected by the two tools. Conclusion AGREE Ⅱ holds high consistency with AGREE-China; however, AGREE-China is more suitable for the quality appraisal of Chinese CPGs or consensus. The methodological quality of CPGs or consensus for the management of FF in China needs to be further improved.
Objective?To assess the effectiveness and safety of diclofenac, one of the routine-used NSAIDs, in preventing post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). Methods Firstly, the electronic searches were conducted to retrieve Randomized controlled trials (RCTs) from The Cochrane Library, PubMed, Embase, OVID, CBM, CNKI, VIP and WanFang Data. Secondly, 12 kinds of specific Chinese journals like Chinese Journal of Gastroenterology and conference proceedings were hand-searched till June 2011, and all references in all included trials were searched, too. The RCTs on diclofenac for preventing PEP were identified and retrieved. The systematic review was conducted by using methods and principles recommended by the Cochrane Collaboration. Results A total of 5 RCTs involving 675 PEP patients were included. The Meta-analysis showed that diclofenac might reduce the incidence of PEP (OR=0.41, 95%CI 0.18 to 0.95, P=0.04), but the sensitivity analysis indicated this result was not stable. No evidence showed diclofenac could reduce the incidence of severe PEP (OR=0.40, 95%CI 0.08 to 2.06, P=0.27). And no adverse reactions related to the drug were reported. Conclusion Diclofenac may be safe and effective in reducing the incidence of PEP, but it has no significant effect on preventing severe PEP. Considering the methodological and scale limitation of included studies, this conclusion still needs to be proved by more large-scale and high-quality RCTs.
Objective To evaluate the diagnostic accuracy of human papillomavirus test for cervical neoplasia. Methods The Cochrane Library (Issue 2, 2010), Cochrane Central Register of Controlled Trials (Issue 2, 2010), and the following databases as CBMdisc, CNKI, MEDLINE, PubMed, and EMbase were all searched from their establishment to June 2010 to get all the randomized control trials (RCTs), and the relevant magazines and the references of the included studies were also searched. The screening, data extraction and quality assessment were conducted in accordance with the inclusion and exclusion criteria by two reviewers independently. The software Metadisc 1.4 was used to perform meta-analyses, and the forest plots and SROC curves were drewn with the RevMan 5.0 software. Results A total of 7 RCTs involving 171 604 subjects were included. The meta-analyses showed, the sensitivity of the HPV test for detecting cervical neoplasia (CIN) was higher than that of the conventional cytology test; the difference in sensitivity for detecting CIN in or above second grade was only found between the test of HPV combined with cervical cytology and the test of conventional cytology (Plt;0.00001), but the HPV test obviously lowered its diagnostic specificity. Among the following three tests for diagnosing CIN, such as, the single test of HPV, the combined test of HPV and cervical cytology, and the test of HPV followed by cytology shunting, the statistic differences compared with the conventional cytology test were found (Plt;0.01) except the last test (P=0.41) which had no difference in diagnosing CIN in or above the first grade. Conclusion The current evidence indicates that, compared with the conventional cytology test, the HPV combined with the cytology test can improve the sensitivity for diagnosing CIN in or above the second grade, but the HPV test cannot improve the specificity for cervical neoplasia. The application of human papillomavirus test for detecting cervical neoplasia needs to be further studied.
Background and Objective Nearly half of million have been reported dead after earthquakes in recent 20 years, and many people always concern seriously about whether those corpses pose a risk to epidemics after earthquakes. An evidence-based approach was conducted to assess the relationship between dead bodies and epidemic disease outbreak systematically. Methods We searched PubMed, The Cochrane Library (Issue 1, 2008), CNKI and WHO website and screened the references of eligible studies. Results A total of 10 papers published beween 1988 to 2007 were included for final analysis, including 2 editorials, 4 reviews and 4 technical reports (technical note or manual). The risk factors for epidemic outbreak after earthquakes were associated primarily with safe water, food and sanitation facilities, as well as the density of population, and no evidence was found that those corpses would pose a risk to the outbreak. But standard infection control precautions should be observed when human corpses were handled. Conclusion Management of dead bodies should be brought into the emergency preparedness system, disaster manuals and guidelines. A community-centered approach to informing communities about the management of the dead following earthquake is also needed. Meanwhile, the myth of about dead bodies and disease outbreak should be dispelled.
Objective To seek the best evidence on communication between physicians and patients so as to improve the physician-patient relationship in China. Methods We used the key words ‘physician-patient relationship’ and ‘communication’ to identify related systematic reviews and meta-analyses, and then evaluated them with the Overview Quality Assessment Questionnaire (OQAQ) checklist. Results Seventeen studies were included for final evaluation. According to the OQAQ checklist, the score range of the study quality was 3 to 9. 41.29% (7/17) of the included studies scored 7 to 9, 23.5% (4/17) scored 6, and 35.3% (6/17) scored 3 to 5. Factors influencing physician-patient communication primarily included communication targets, time, contents, and approaches. Conclusion There are not enough studies on physician-patient communication in China. We need to identify the problems affecting communication behavior, encourage patients to express their preferences, choose appropriate training strategies, and make timely evaluation so as to better satisfy the needs of patients and physicians.