ObjectiveTo investigate the efficacy of subclavian-carotid transposition (SCT) in treating patients with proximal subclavian artery occlusive diseases who were unable to be intervened, such as failure of intervention, congenital malformation and unwillingness to intervention.MethodsA retrospective review of 19 patients with proximal subclavian artery occlusion who underwent SCT from May 2016 to December 2018 was done. There were 14 males and 5 females with an average age of 54.05±17.34 years. The advantages and disadvantages of SCT in the treatment of proximal subclavian artery occlusion were analyzed.ResultsAll patients achieved immediate remission of symptoms after surgery. The stenosis degree of the proximal subclavian artery decreased from 100.0%±0.0% to 12.7%±10.1% after surgery. The average blood pressure difference between the unaffected side and the affected side decreased from 11.95±10.60 mm Hg to 0.89±5.75 mm Hg (P<0.01). Peripheral nerve injury occurred in 7 (36.8%) patients. The in-patient cost of subclavian artery occlusion patients who received subclavian artery interventional therapy in our hospital during the corresponding period was 3 392.12 yuan higher than that of the SCT group in average (if eliminating the patients whose cost was far from the average value, the cost of interventional therapy was 4 812.01 yuan higher than that of the SCT group in average). During 1-3 years' follow-up, 6 patients with neurological complication relieved. One- and three-year patency rates were 100.0%. No perioperative stroke, death or re-operation happened.ConclusionSCT is an ideal process for the patients with subclavian artery occlusion who cannot accept subclavian artery interventional therapy.
Umbrella review is a research method that comprehensively analyzes the systematic reviews and meta-analysis of a research question. In recent years, the research methods of umbrella review have been widely used, but the quality of umbrella review is uneven. Therefore, this paper focuses on the production methods and existing challenges of umbrella review, in order to provide references for domestic researchers to make umbrella review.
AutoMeta is a semi-automated, interactive, user-friendly online platform developed by Chinese scholars with independent intellectual property rights. This platform is designed to assist users in completing pairwise meta-analysis, inverse variance meta-analysis, network meta-analysis, and diagnostic test accuracy meta-analysis and use the GRADE method to achieve automatic grading of certainty of evidence. Nowadays, the AutoMeta platform can conduct the pairwise meta-analysis and inverse variance meta-analysis, as well as the automatic grading of certainty of evidence for pairwise meta-analysis. This article introduces the platform to users in terms of its development techniques, operation methods and verification of the accuracy of results, aiming to assist researchers to conduct systematic reviews quickly.
Scientific and rigorous study design could improve the reliability of results of the comparative diagnostic test accuracy studies. The design procedures of a comparative diagnostic test accuracy study included: constructing the clinical questions, identifying the appropriate gold standard, selecting the representative patient sample, calculating the sample size, blindly interpreting and comparing the results of diagnostic tests, and setting up the cut-off value. This paper introduced 5 categories of the designs of comparative diagnostic test accuracy studies: fully paired, partially paired with a random subset, partially paired with a nonrandom subset, unpaired randomized, and unpaired nonrandomized design.
High-quality randomized controlled trials are the best source of evidence to explain the relationship between health interventions and outcomes. However, in cases where they are insufficient, indirect, or inappropriate, researchers may need to include non-randomized studies of interventions to strengthen the evidence body and improve the certainty (quality) of evidence. The latest research from the GRADE working group provides a way for researchers to integrate randomized and non-randomized evidence. The present paper introduced the relevant methods to provide guidance for systematic reviewers, health technology assessors, and guideline developers.
Comparative diagnostic test accuracy study, a type of diagnostic accuracy test, aims to compare accuracy of two or more index tests in a study. The application of GRADE in comparative test accuracy differs from single test accuracy, mainly including the selection of appropriate comparative study designs, additional criteria for judging risk of bias, and the consequences of using comparative measures of test accuracy. The study focuses on basic principles and methods of GRADE approach in systematic reviews of comparative test accuracy to promote the understanding and application of the method by domestic scholars.
The comparative diagnostic test accuracy (CDTA) study is an important part of diagnostic test accuracy, which aims to compare the accuracy of two or more index tests in the same study. With the development of CDTA studies and the methodology of systematic reviews, the number of CDTA systematic reviews has grown year by year and has provided evidence to support clinical decision-making. Compared with systematic review of single diagnostic test accuracy, the CDTA systematic review has its own unique features, especially in data extraction, risk of bias, and statistical analysis. This paper introduced the steps and precautions for writing a CDTA systematic review to provide references for CDTA systematic reviewers.
With the rapid development of medicine and the emergence of new evidence, the formulation of living guidelines is significant in guiding clinical practice and providing timely and effective references for clinical workers. This article summarizes the status of living guidelines, and puts forward thoughts and suggestions on the challenges and opportunities of the development of living guidelines, in order to promote the development of living guidelines and provide a reference for guideline developers and users.
Objective To overview the systematic reviews/meta-analysis (SR/MA) for the effectiveness of yoga on patients with type 2 diabetes mellitus. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Cochrane Library, Embase, Web of Science, JBI and CINAHL databases were electronically searched to collect SR/MA on the intervention of yoga in diabetes mellitus from inception to November 6th, 2023. Two researchers independently screened the literature and extracted data. AMSTAR was used to evaluate the quality of methodology, and GRADE was used to evaluate the certainty of evidence, and the outcome indicators were statistically analyzed. Results A total of 14 SR/MA were included. The evaluation results of AMSTAR showed that 7 articles were of high quality and 7 articles were of moderate quality. The result of GRADE showed that there were 2 items of high-level evidence, 26 items of intermediate evidence, and the remaining 31 items were low-level or very low-level evidence. The results showed that yoga could significantly reduce fasting blood glucose (FBG) (moderate confidence), glycosylated hemoglobin (HA1C) (moderate confidence) and postprandial blood glucose (PPBG) levels (moderate confidence), and was also superior to other interventions in high-density cholesterol (HDL) (moderate confidence), low-density cholesterol (LDL) (moderate confidence), triglyceride (TG) (moderate confidence), total cholesterol (TC) (moderate confidence), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (moderate confidence), muscle strength (high confidence), cardiorespiratory fitness (moderate confidence) and weight (moderate confidence). Conclusion The existing evidence shows that yoga has a good effect on blood glucose control (moderate confidence) and also has a certain effect on lipid parameters (moderate confidence) and anthropometric indicators (moderate confidence), but the quality and confidence of the current research evidence are low. Future researchers should standardize the research design to provide more high-quality evidence for the prognosis and treatment of type 2 diabetes mellitus.
Previous methods of grading evidence for systematic reviews of diagnostic test accuracy have generally focused on assessing the certainty (quality) of evidence at the level of diagnostic indicators. When the question is not limited to follow the diagnostic test accuracy results themselves, the grading results may be inaccurate due to the lack of consideration of the downstream effects of the test accuracy in specific settings. To address these challenges, the GRADE working group conducted a series of studies focused on updating methods to explore or simulate important downstream effects of diagnostic test accuracy outcomes within a contextual framework. This paper aimed to introduce advances in the contextual framework of the GRADE approach to rate the certainty of evidence from systematic reviews of single diagnostic test accuracy.