1
|
Ghosh NR, Esmaeilinezhad Z, Zając J, Creasy RA, Lorenz SG, Klatt KC, Bala MM, Beathard KM, Johnston BC. Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review. J Nutr 2024; 154:1414-1427. [PMID: 38159813 DOI: 10.1016/j.tjnut.2023.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. RESULTS We identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. CONCLUSIONS The overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners. This study was registered at PROSPERO as CRD42022311916.
Collapse
Affiliation(s)
- Nirjhar R Ghosh
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Zahra Esmaeilinezhad
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Joanna Zając
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Rebecca A Creasy
- Department of Food Science and Technology, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Saundra G Lorenz
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Kevin C Klatt
- Department of Nutrition Sciences and Toxicology, University of California, Berkeley, CA, United States
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Karen M Beathard
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States
| | - Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX, United States; Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, USA.
| |
Collapse
|
2
|
Storman D, Swierz MJ, Mitus JW, Pedziwiatr M, Liang N, Wolff R, Bala MM. Microwave coagulation for liver metastases. Cochrane Database Syst Rev 2024; 3:CD010163. [PMID: 38534000 PMCID: PMC10966940 DOI: 10.1002/14651858.cd010163.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
BACKGROUND Liver metastases (i.e. secondary hepatic malignancies) are significantly more common than primary liver cancer. Long-term survival after radical surgical treatment is approximately 50%. For people in whom resection for cure is not feasible, other treatments must be considered. One treatment option is microwave coagulation utilising electromagnetic waves. It involves placing an electrode into a lesion under ultrasound or computed tomography guidance. OBJECTIVES To evaluate the beneficial and harmful effects of microwave coagulation versus no intervention, other ablation methods, or systemic treatments in people with liver metastases regardless of the location of the primary tumour. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest date of search was 14 April 2023. SELECTION CRITERIA Randomised clinical trials assessing beneficial or harmful effects of microwave coagulation and its comparators in people with liver metastases, irrespective of the location of the primary tumour. We included trials no matter the outcomes reported. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures. Our primary outcomes were: all-cause mortality at the last follow-up and time to mortality; health-related quality of life (HRQoL); and any adverse events or complications. Our secondary outcomes were: cancer mortality; disease-free survival; failure to clear liver metastases; recurrence of liver metastases; time to progression of liver metastases; and tumour response measures. We used risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) to present the results. Two review authors independently extracted data and assessed the risk of bias using the Cochrane RoB 1 tool. We used GRADE methodology to assess the certainty of the evidence. MAIN RESULTS Three randomised clinical trials fulfilled the inclusion criteria. The control interventions differed in the three trials; therefore, meta-analyses were not possible. The trials were at high risk of bias. The certainty of evidence of the assessed outcomes in the three comparisons was very low. Data on our prespecified outcomes were either missing or not reported. Microwave coagulation plus conventional transarterial chemoembolisation (TACE) versus conventional TACE alone One trial, conducted in China, randomised 50 participants (mean age 60 years, 76% males) with liver metastases from various primary sites. Authors reported that the follow-up period was at least one month. The trial reported adverse events or complications in the experimental group only and for tumour response measures. There were no dropouts in the trial. The trial did not report on any other outcomes. Microwave ablation versus conventional surgery One trial, conducted in Japan, randomised 40 participants (mean age 61 years, 53% males) with multiple liver metastases of colorectal cancer. Ten participants were excluded after randomisation (six from the experimental and four from the control group); thus, the trial analyses included 30 participants. Follow-up was three years. The reported number of deaths from all causes was 9/14 included participants in the microwave group versus 12/16 included participants in the conventional surgery group. The mean overall survival was 27 months in the microwave ablation and 25 months in the conventional surgery group. The three-year overall survival was 14% with microwave ablation and 23% with conventional surgery, resulting in an HR of 0.91 (95% CI 0.39 to 2.15). The reported frequency of adverse events or complications was comparable between the two groups, except for the required blood transfusion, which was more common in the conventional surgery group. There was no intervention-related mortality. Disease-free survival was 11.3 months in the microwave ablationgroup and 13.3 months in the conventional surgery group. The trial did not report on HRQoL. Microwave ablation versus radiofrequency ablation One trial, conducted in Germany, randomised 50 participants (mean age 62.8 years, 46% males) who were followed for 24 months. Two-year mortality showed an RR of 0.62 (95% CI 0.26 to 1.47). The trial reported that, by two years, 76.9% of participants in the microwave ablationgroup and 62.5% of participants in the radiofrequency ablation group survived (HR 0.63, 95% CI 0.23 to 1.73). The trial reported no deaths or major complications during the procedures in either group. There were two minor complications only in the radiofrequency ablation group (RR 0.19, 95% CI 0.01 to 3.67). The trial reported technical efficacy in 100% of procedures in both groups. Distant recurrence was reported for 10 participants in the microwave ablation group and nine participants in the radiofrequency ablation group (RR 1.03, 95% CI 0.50 to 2.08). No participant in the microwave ablation group demonstrated local progression at 12 months, while that occurred in two participants in the radiofrequency ablation group (RR 0.19, 95% CI 0.01 to 3.67). The trial did not report on HRQoL. One trial reported partial support by Medicor (MMS Medicor Medical Supplies GmbH, Kerpen, Germany) for statistical analysis. The remaining two trials did not provide information on funding. We identified four ongoing trials. AUTHORS' CONCLUSIONS The evidence is very uncertain about the effect of microwave ablation in addition to conventional TACE compared with conventional TACE alone on adverse events or complications. We do not know if microwave ablation compared with conventional surgery may have little to no effect on all-cause mortality. We do not know the effect of microwave ablation compared with radiofrequency ablation on all-cause mortality and adverse events or complications either. Data on all-cause mortality and time to mortality, HRQoL, adverse events or complications, cancer mortality, disease-free survival, failure to clear liver metastases, recurrence of liver metastases, time to progression of liver metastases, and tumour response measures were either insufficient or were lacking. In light of the current inconclusive evidence and the substantial gaps in data, the pursuit of additional good-quality, large randomised clinical trials is not only justified but also essential to elucidate the efficacy and comparative benefits of microwave ablation in relation to various interventions for liver metastases. The current version of the review, in comparison to the previous one, incorporates two new trials in two additional microwave ablation comparisons: 1. in addition to conventional TACE versus conventional TACE alone and 2. versus radiofrequency ablation.
Collapse
Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy W Mitus
- Department of Surgical Oncology, The Maria Sklodowska-Curie National Research Institute of Oncology, Krakow Branch; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Pedziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Ning Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | | | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
3
|
Wang Y, Xia R, Pericic TP, Bekkering GE, Hou L, Bala MM, Gao Y, Wu M, Gloss D, Siemieniuk RA, Fei Y, Rochwerg B, Guyatt G, Brignardello-Petersen R. How do network meta-analyses address intransitivity when assessing certainty of evidence: a systematic survey. BMJ Open 2023; 13:e075212. [PMID: 38035750 PMCID: PMC10689416 DOI: 10.1136/bmjopen-2023-075212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES To describe how systematic reviews with network meta-analyses (NMAs) that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) NMA approach addressed intransitivity when assessing certainty of evidence. DESIGN Systematic survey. DATA SOURCES Medline, Embase and Cochrane Database of Systematic Reviews from September 2014 to October 2022. ELIGIBILITY CRITERIA Systematic reviews of randomised controlled trials with aggregate data NMAs that used the GRADE NMA approach for assessing certainty of evidence. DATA EXTRACTION AND SYNTHESIS We documented how reviewers described methods for addressing intransitivity when assessing certainty of evidence, how often they rated down for intransitivity and their explanations for rating down. RESULTS Of the 268 eligible systematic reviews, 44.8% (120/268) mentioned intransitivity when describing methods for assessing the certainty of evidence. Of these, 28.3% (34/120) considered effect modifiers and from this subset, 67.6% (23/34) specified the effect modifiers; however, no systematic review noted how they chose the effect modifiers. 15.0% (18/120) mentioned looking for differences between the direct comparisons that inform the indirect estimate. No review specified a threshold for difference in effect modifiers between the direct comparisons that would lead to rating down for intransitivity. Reviewers noted rating down indirect evidence for intransitivity in 33.1% of systematic reviews, and noted intransitivity for network estimates in 23.0% of reviews. Authors provided an explanation for rating down for intransitivity in 59.6% (31/52) of the cases in which they rated down. Of the 31 in which they provided an explanation, 74.2% (23/31) noted they detected differences in effect modifiers and 67.7% (21/31) specified in what effect modifiers they detected differences. CONCLUSIONS A third of systematic reviews with NMAs using the GRADE approach rated down for intransitivity. Limitations in reporting of methods to address intransitivity proved considerable. Whether the problem is that reviewers neglected to address rating down for transitivity at all, or whether they did consider but not report, is not clear. At minimum systematic reviews with NMAs need to improve their reporting practices regarding intransitivity; it may well be that they need to improve their practice in transitivity assessment. How to best address intransitivity may remain unclear for many reviewers thus additional GRADE guidance providing practical instructions for addressing intransitivity may be desirable.
Collapse
Affiliation(s)
- Ying Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ruyu Xia
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | | | | | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Ya Gao
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Michael Wu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Gloss
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Reed Alexander Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | |
Collapse
|
4
|
Wang Y, Florez ID, Morgan RL, Foroutan F, Chang Y, Crandon HN, Zeraatkar D, Bala MM, Mao RQ, Tao B, Shahid S, Wang X, Beyene J, Offringa M, Sherman PM, El Gouhary E, Guyatt GH, Sadeghirad B. Probiotics, Prebiotics, Lactoferrin, and Combination Products for Prevention of Mortality and Morbidity in Preterm Infants: A Systematic Review and Network Meta-Analysis. JAMA Pediatr 2023; 177:1158-1167. [PMID: 37782505 PMCID: PMC10546299 DOI: 10.1001/jamapediatrics.2023.3849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/01/2023] [Indexed: 10/03/2023]
Abstract
Importance Modulation of intestinal microbiome by administering probiotics, prebiotics, or both may prevent morbidity and mortality in premature infants. Objective To assess the comparative effectiveness of alternative prophylactic strategies through a network meta-analysis (NMA) of randomized clinical trials. Data Sources MEDLINE, EMBASE, Science Citation Index Expanded, CINAHL, Scopus, Cochrane CENTRAL, and Google Scholar from inception until May 10, 2023. Study Selection Eligible trials tested probiotics, prebiotics, lactoferrin, and combination products for prevention of morbidity or mortality in preterm infants. Data Extraction and Synthesis A frequentist random-effects model was used for the NMA, and the certainty of evidence and inferences regarding relative effectiveness were assessed using the GRADE approach. Main Outcomes and Measures All-cause mortality, severe necrotizing enterocolitis, culture-proven sepsis, feeding intolerance, time to reach full enteral feeding, and duration of hospitalization. Results A total of 106 trials involving 25 840 preterm infants were included. Only multiple-strain probiotics were associated with reduced all-cause mortality compared with placebo (risk ratio [RR], 0.69; 95% CI, 0.56 to 0.86; risk difference [RD], -1.7%; 95% CI, -2.4% to -0.8%). Multiple-strain probiotics alone (vs placebo: RR, 0.38; 95% CI, 0.30 to 0.50; RD, -3.7%; 95% CI, -4.1% to -2.9%) or in combination with oligosaccharides (vs placebo: RR, 0.13; 95% CI, 0.05 to 0.37; RD, -5.1%; 95% CI, -5.6% to -3.7%) were among the most effective interventions reducing severe necrotizing enterocolitis. Single-strain probiotics in combination with lactoferrin (vs placebo RR, 0.33; 95% CI, 0.14 to 0.78; RD, -10.7%; 95% CI, -13.7% to -3.5%) were the most effective intervention for reducing sepsis. Multiple-strain probiotics alone (RR, 0.61; 95% CI, 0.46 to 0.80; RD, -10.0%; 95% CI, -13.9% to -5.1%) or in combination with oligosaccharides (RR, 0.45; 95% CI, 0.29 to 0.67; RD, -14.1%; 95% CI, -18.3% to -8.5%) and single-strain probiotics (RR, 0.61; 95% CI, 0.51 to 0.72; RD, -10.0%; 95% CI, -12.6% to -7.2%) proved of best effectiveness in reduction of feeding intolerance vs placebo. Single-strain probiotics (MD, -1.94 days; 95% CI, -2.96 to -0.92) and multistrain probiotics (MD, -2.03 days; 95% CI, -3.04 to -1.02) proved the most effective in reducing the time to reach full enteral feeding compared with placebo. Only single-strain and multistrain probiotics were associated with greater effectiveness compared with placebo in reducing duration of hospitalization (MD, -3.31 days; 95% CI, -5.05 to -1.58; and MD, -2.20 days; 95% CI, -4.08 to -0.31, respectively). Conclusions and Relevance In this systematic review and NMA, moderate- to high-certainty evidence demonstrated an association between multistrain probiotics and reduction in all-cause mortality; these interventions were also associated with the best effectiveness for other key outcomes. Combination products, including single- and multiple-strain probiotics combined with prebiotics or lactoferrin, were associated with the largest reduction in morbidity and mortality.
Collapse
Affiliation(s)
- Yuting Wang
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Ivan D. Florez
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, University of Antioquia, Medellin, Colombia
- Pediatric Intensive Care Unit, Clínica Las Americas-AUNA, Medellin, Colombia
| | - Rebecca L. Morgan
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Yaping Chang
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Holly N. Crandon
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M. Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Randi Q. Mao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Brendan Tao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaneela Shahid
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Xiaoqin Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Philip M. Sherman
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Enas El Gouhary
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
5
|
Puljak L, Bala MM, Mathes T, Poklepovic Pericic T, Wegewitz U, Faggion CM, Matthias K, Storman D, Zajac J, Rombey T, Bruschettini M, Pieper D. AMSTAR 2 is only partially applicable to systematic reviews of non-intervention studies: a meta-research study. J Clin Epidemiol 2023; 163:11-20. [PMID: 37659582 DOI: 10.1016/j.jclinepi.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES A measurement tool to assess systematic reviews 2 (AMSTAR 2) was originally developed for systematic reviews (SRs) of health-care interventions. The aim of this study was to assess the applicability of AMSTAR 2 to SRs of non-intervention studies. STUDY DESIGN AND SETTING This was a meta-research study. We used 20 SRs for each of the following four types of SRs: Diagnostic Test Accuracy reviews, Etiology and/or Risk reviews, Prevalence and/or Incidence reviews, and Prognostic reviews (80 in total). Three authors applied AMSTAR 2 independently to each included SRs. Then, the authors assessed the applicability of each item to that SR type and any SR type. RESULTS Researchers unanimously indicated that 7 of 16 AMSTAR 2 items were applicable for all four specific SR types and any SR type (items 2, 5, 6, 7, 10, 14 and 16), but 8 of 16 items for any SR type. These items could cover generic SR methods that do not depend on a specific SR type. CONCLUSION AMSTAR 2 is only partially applicable for non-intervention SRs. There is a need to adapt/extend AMSTAR 2 for SRs of non-intervention studies. Our study can help to further define generic methodological aspects shared across SR types and methodological expectations for non-intervention SRs.
Collapse
Affiliation(s)
- Livia Puljak
- Center for Evidence-Based Medicine and Healthcare, Catholic University of Croatia, Zagreb, Croatia.
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Tim Mathes
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Tina Poklepovic Pericic
- Department of Prosthodontics, Study of Dental Medicine, University of Split School of Medicine, Split, Croatia
| | - Uta Wegewitz
- Division 3 Work and Health, Federal Institute for Occupational Safety and Health (BAuA), Berlin, Germany
| | - Clovis M Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| | - Katja Matthias
- Faculty of Electrical Engineering and Computer Science, University of Applied Science Stralsund, Stralsund, Germany
| | - Dawid Storman
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tanja Rombey
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden; Department of Research and Education, Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| | - Dawid Pieper
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Institute for Health Services and Health System Research, Rüdersdorf, Germany; Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| |
Collapse
|
6
|
Meneses-Echavez JF, Bidonde J, Montesinos-Guevara C, Amer YS, Loaiza-Betancur AF, Tellez Tinjaca LA, Fraile Navarro D, Poklepović Peričić T, Tokalić R, Bala MM, Storman D, Swierz M, Zając J, Flórez ID, Schünemann H, Flottorp S, Alonso-Coello P. Using evidence to decision frameworks led to guidelines of better quality and more credible and transparent recommendations. J Clin Epidemiol 2023; 162:38-46. [PMID: 37517506 DOI: 10.1016/j.jclinepi.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND AND OBJECTIVES To determine whether the use of Evidence to Decision (EtD) frameworks is associated to higher quality of both guidelines and individual recommendations. METHODS We identified guidelines recently published by international organizations that have methodological guidance documents for their development. Pairs of researchers independently extracted information on the use of these frameworks, appraised the quality of the guidelines using the Appraisal of Guidelines, Research and Evaluation II Instrument (AGREE-II), and assessed the clinical credibility and implementability of the recommendations with the Appraisal of Guidelines for REsearch & Evaluation Recommendations Excellence (AGREE-REX) tool. We conducted both descriptive and inferential analyses. RESULTS We included 66 guidelines from 17 different countries, published in the last 5 years. Thirty guidelines (45%) used an EtD framework to formulate their recommendations. Compared to those that did not use a framework, those using an EtD framework scored higher in all domains of both AGREE-II and AGREE-REX (P < 0.05). Quality scores did not differ between the use of the The Grading of Recommendations Assessment, Development and Evaluation-EtD framework (17 guidelines) or another EtD framework (13 guidelines) (P > 0.05). CONCLUSION The use of EtD frameworks is associated with guidelines of better quality, and more credible and transparent recommendations. Endorsement of EtD frameworks by guideline developing organizations will likely increase the quality of their guidelines.
Collapse
Affiliation(s)
- Jose F Meneses-Echavez
- Norwegian Institute of Public Health, Oslo, Norway; Facultad de Cultura Física, Deporte y Recreación, Universidad Santo Tomás, Bogotá, Colombia.
| | - Julia Bidonde
- Norwegian Institute of Public Health, Oslo, Norway; School of Rehabilitation Science, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Camila Montesinos-Guevara
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Yasser S Amer
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, Pediatrics Department, King Saud University Medical City, Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | - Andres Felipe Loaiza-Betancur
- Instituto Universitario de Educación Física, Universidad de Antioquia, Medellín, Colombia; Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia
| | - Luis Andres Tellez Tinjaca
- Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás, Tunja, Colombia
| | - David Fraile Navarro
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia; Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tina Poklepović Peričić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ružica Tokalić
- Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Department of Adult Psychiatry, University Hospital Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Zając
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Ivan D Flórez
- Department of Pediatrics, University of Antioquia, Calle 67 No. 53-108, Medellin, Colombia; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Pediatric Intensive Care Unit, Clínica Las Américas-AUNA, Medellín, Colombia
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Signe Flottorp
- Norwegian Institute of Public Health, Oslo, Norway; Institute of Health and Society, University of Oslo, Oslo, Norway
| | | |
Collapse
|
7
|
Johnston BC, Zeraatkar D, Steen J, de Jauregui DRF, Zhu H, Sun M, Cooper M, Maraj M, Prokop-Dorner A, Reyes BC, Valli C, Storman D, Karam G, Zajac J, Ge L, Swierz MJ, Ghosh N, Vernooij RWM, Chang Y, Zhao Y, Thabane L, Guyatt GH, Alonso-Coello P, Hooper L, Bala MM. Saturated fat and human health: a protocol for a methodologically innovative systematic review and meta-analysis to inform public health nutrition guidelines. Syst Rev 2023; 12:39. [PMID: 36918997 PMCID: PMC10012519 DOI: 10.1186/s13643-023-02209-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND The health effects of dietary fats are a controversial issue on which experts and authoritative organizations have often disagreed. Care providers, guideline developers, policy-makers, and researchers use systematic reviews to advise patients and members of the public on optimal dietary habits, and to formulate public health recommendations and policies. Existing reviews, however, have serious limitations that impede optimal dietary fat recommendations, such as a lack of focus on outcomes important to people, substantial risk of bias (RoB) issues, ignoring absolute estimates of effects together with comprehensive assessments of the certainty of the estimates for all outcomes. OBJECTIVE We therefore propose a methodologically innovative systematic review using direct and indirect evidence on diet and food-based fats (i.e., reduction or replacement of saturated fat with monounsaturated or polyunsaturated fat, or carbohydrates or protein) and the risk of important health outcomes. METHODS We will collaborate with an experienced research librarian to search MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews (CDSR) for randomized clinical trials (RCTs) addressing saturated fat and our health outcomes of interest. In duplicate, we will screen, extract results from primary studies, assess their RoB, conduct de novo meta-analyses and/or network meta-analysis, assess the impact of missing outcome data on meta-analyses, present absolute effect estimates, and assess the certainty of evidence for each outcome using the GRADE contextualized approach. Our work will inform recommendations on saturated fat based on international standards for reporting systematic reviews and guidelines. CONCLUSION Our systematic review and meta-analysis will provide the most comprehensive and rigorous summary of the evidence addressing the relationship between saturated fat modification for people-important health outcomes. The evidence from this review will be used to inform public health nutrition guidelines. TRIAL REGISTRATION PROSPERO Registration: CRD42023387377 .
Collapse
Affiliation(s)
- Bradley C Johnston
- Department of Nutrition, College of Agriculture and Life Science, Texas A&M University, College Station, TX, USA. .,Department of Epidemiology and Biostatistics, School of Public Health, College Station, TX, USA.
| | - Dena Zeraatkar
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jeremy Steen
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Diego Rada Fernandez de Jauregui
- Preventive Medicine and Public Health Department, School of Pharmacy, University of the Basque Country/Euskal Herriko Unibertsitatea (UPV/EHU), Vitoria-Gasteiz, Spain.,Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Hongfei Zhu
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mingyao Sun
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Matthew Cooper
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Malgorzata Maraj
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Boris Castro Reyes
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Dawid Storman
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.,Department of Adult Psychiatry, University Hospital, Krakow, Poland
| | - Giorgio Karam
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Jagiellonian University Medical College, Krakow, Poland
| | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mateusz J Swierz
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Nirjhar Ghosh
- Department of Nutrition, Texas A&M University, College Station, TX, USA
| | - Robin W M Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yaping Chang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,The Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, China
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología Y Salud Pública (CIBERESP), Madrid, Spain
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
8
|
Brini S, Brudasca NI, Hodkinson A, Kaluzinska K, Wach A, Storman D, Prokop-Dorner A, Jemioło P, Bala MM. Efficacy and safety of transcranial magnetic stimulation for treating major depressive disorder: An umbrella review and re-analysis of published meta-analyses of randomised controlled trials. Clin Psychol Rev 2023; 100:102236. [PMID: 36587461 DOI: 10.1016/j.cpr.2022.102236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We re-analysed data from published meta-analyses testing the effects of Transcranial Magnetic Stimulation (TMS) on Major Depressive Disorder (MDD) in adults. We applied up-to-date meta-analytic techniques for handling heterogeneity including the random-effects Hartung-Knapp-Sidik-Jonkman method and estimated 95% prediction intervals. Heterogeneity practices in published meta-analyses were assessed as a secondary aim. STUDY DESIGN AND SETTING We performed systematic searches of systematic reviews with meta-analyses that included randomised controlled trials assessing the efficacy, tolerability, and side effects of TMS on MDD. We performed risk of bias assessment using A MeaSurement Tool to Assess Reviews (AMSTAR) 2 and re-analysed meta-analyses involving 10 or more primary studies. RESULTS We included 29 systematic reviews and re-analysed 15 meta-analyses. Authors of all meta-analyses interpreted findings to suggest TMS is safe and effective for MDD. Our re-analysis showed that in 14 out of 15 meta-analyses, the 95% prediction intervals included the null and captured values in the opposite effect direction. We also detected presence of small-study effects in some meta-analyses and 24 out of 25 systematic reviews received an AMSTAR 2 rating classed as critically low. CONCLUSION Authors of all included meta-analyses interpreted findings to suggest TMS is safe and effective for MDD despite lack of comprehensive investigation of heterogeneity. Our re-analysis revealed the direction and magnitude of treatment effects vary widely across different settings. We also found high risk of bias in the majority of included systematic reviews and presence of small-study effects in some meta-analyses. Because of these reasons, we argue TMS for MDD may not be as effective and potentially less tolerated in some populations than current evidence suggests.
Collapse
Affiliation(s)
- S Brini
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom.
| | - N I Brudasca
- Division of Health Services Research and Management School of Health Sciences, City, University of London, London, United Kingdom
| | - A Hodkinson
- National Institute for Health Research (NIHR), School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, United Kingdom
| | - K Kaluzinska
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - A Wach
- Jagiellonian University Medical College, Faculty of Medicine, Students' Scientific Group of Systematic Reviews, Kraków, Poland
| | - D Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - A Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
| | - P Jemioło
- AGH University of Science and Technology, Kraków, Poland
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
9
|
Valli C, Maraj M, Prokop-Dorner A, Kaloteraki C, Steiner C, Rabassa M, Solà I, Zajac J, Johnston BC, Guyatt GH, Bala MM, Alonso-Coello P. People's Values and Preferences about Meat Consumption in View of the Potential Environmental Impacts of Meat: A Mixed-methods Systematic Review. Int J Environ Res Public Health 2022; 20:286. [PMID: 36612609 PMCID: PMC9819158 DOI: 10.3390/ijerph20010286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Health is not the only aspect people consider when choosing to consume meat; environmental concerns about the impact of meat (production and distribution) can influence people's meat choices. METHODS We conducted a mixed-methods systematic review, searched six databases from inception to June 2020, and synthesised our findings into narrative forms. We integrated the evidence from quantitative and qualitative data sets into joint displays and assessed the confidence in the evidence for each review finding following the GRADE-CERQual approach. RESULTS Of the 23,531 initial records, we included 70 studies: 56 quantitative, 12 qualitative, and 2 mixed-methods studies. We identified four main themes: (1) reasons for eating meat; (2) reasons for avoiding meat; (3) willingness to change meat consumption; and (4) willingness to pay more for environmentally friendly meat. The overall confidence was low for the reasons for eating and/or buying meat, for avoiding meat, and for willingness to change meat consumption, and was moderate for willingness to pay more for environmentally friendly meat. CONCLUSIONS Regardless of people's general beliefs about meat and its impact on the environment, most people may be unwilling to change their meat consumption. Future research should address the current limitations of the research evidence to assess whether people are willing to make a change when properly informed.
Collapse
Affiliation(s)
- Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, 08193 Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), 08037 Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Małgorzata Maraj
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Chrysoula Kaloteraki
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Corinna Steiner
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Joanna Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Bradley C. Johnston
- Department of Nutrition, College of Agriculture and Life Sciences, Texas A&M University, College Station, TX 77843, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Gordon H. Guyatt
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Malgorzata M. Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), 08025 Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| |
Collapse
|
10
|
Świątkiewicz-Mośny M, Prokop-Dorner A, Ślusarczyk M, Ożegalska-Łukasik N, Piłat-Kobla A, Zając J, Bala MM. When Peppa Pig and Confucius meet, joining forces on the battlefield of health literacy-a qualitative analysis of COVID-19 educational materials for children and adolescents from China, the USA, and Europe. PLoS One 2022; 17:e0278554. [PMID: 36472972 PMCID: PMC9725119 DOI: 10.1371/journal.pone.0278554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
In times of pandemic, health literacy (HL) is very important, as it helps to find, understand, and use essential health information and services. According to WHO, HL is pivotal in fighting infodemic effectively, and education is a vital tool for developing it. In the presented work, we analyze 247 educational materials dedicated to children, adolescents, and their carers explaining the pandemic, prepared by the Chinese, American, German, Italian and Polish governments and international non-governmental organizations. Focusing on the textual and visual side of the documents, we investigated how the pandemic is explained and what discursive measures were used to inform young citizens about the risks and consequences of pandemic restrictions. Additionally, we verified whether the materials helped developing critical thinking, which is crucial to prevent spreading fake news and conspiracy theories. Although the analyzed materials were prepared in different cultural contexts, we identified that all of them contained simple instructions on the desired behaviours during the pandemic. Key messages relating to the importance of hygienic behaviors were often supplemented with guidelines on how to successfully complete each action. While the cultural particularities in presenting the state of the pandemic are visible, the challenges of dealing with the emotional and social crises were dominant all around the world. In our study, we argue that the possibilities of building HL were not fully exploited by the national and international institutions. Citizens were taught how to behave in unusual circumstances but not why they should behave differently. The educational materials lacked reliable knowledge that would allow them to deal with infodemic and develop critical thinking. We conclude that health education expertise worldwide should be focused on enhancing individuals' ability to make informed health decisions and provide three recommendations regarding the process of development of health educational resources for children and the youth.
Collapse
Affiliation(s)
| | - Anna Prokop-Dorner
- Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
- * E-mail:
| | | | | | - Aleksandra Piłat-Kobla
- Department of Medical Sociology, Jagiellonian University Medical College, Kraków, Poland
| | - Joanna Zając
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Malgorzata M. Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| |
Collapse
|
11
|
Storman D, Jemioło P, Swierz MJ, Sawiec Z, Antonowicz E, Prokop-Dorner A, Gotfryd-Burzyńska M, Bala MM. Meeting the Unmet Needs of Individuals With Mental Disorders: Scoping Review on Peer-to-Peer Web-Based Interactions. JMIR Ment Health 2022; 9:e36056. [PMID: 36469366 PMCID: PMC9788841 DOI: 10.2196/36056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 06/24/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND An increasing number of online support groups are providing advice and information on topics related to mental health. OBJECTIVE This study aimed to investigate the needs that internet users meet through peer-to-peer interactions. METHODS A search of 4 databases was performed until August 15, 2022. Qualitative or mixed methods (ie, qualitative and quantitative) studies investigating interactions among internet users with mental disorders were included. The φ coefficient was used and machine learning techniques were applied to investigate the associations between the type of mental disorders and web-based interactions linked to seeking help or support. RESULTS Of the 13,098 identified records, 44 studies (analyzed in 54 study-disorder pairs) that assessed 82,091 users and 293,103 posts were included. The most frequent interactions were noted for people with eating disorders (14/54, 26%), depression (12/54, 22%), and psychoactive substance use disorders (9/54, 17%). We grouped interactions between users into 42 codes, with the empathy or compassion code being the most common (41/54, 76%). The most frequently coexisting codes were request for information and network (35 times; φ=0.5; P<.001). The algorithms that provided the best accuracy in classifying disorders by interactions were decision trees (44/54, 81%) and logistic regression (40/54, 74%). The included studies were of moderate quality. CONCLUSIONS People with mental disorders mostly use the internet to seek support, find answers to their questions, and chat. The results of this analysis should be interpreted as a proof of concept. More data on web-based interactions among these people might help apply machine learning methods to develop a tool that might facilitate screening or even support mental health assessment.
Collapse
Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Jemioło
- AGH University of Science and Technology, Krakow, Poland
| | - Mateusz Jan Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Zuzanna Sawiec
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Antonowicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | | | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
12
|
Bala MM. The benefit of dynamic neutrophil-lymphocyte ratio and systemic immune-inflammation index in predicting survival in patients undergoing hemiarthroplasty. Eur Rev Med Pharmacol Sci 2022; 26:3878-3885. [PMID: 35731057 DOI: 10.26355/eurrev_202206_28955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We aimed at investigating the relationship between the values of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) in the preoperative and postoperative periods in patients who underwent hemiarthroplasty. PATIENTS AND METHODS The medical records of patients aged >65 years who underwent hemiarthroplasty due to hip fracture in our institution between January 2017 and December 2020 were examined. Dynamic Neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (dPLR), and systemic immune-inflammation index (dSII) were calculated using biomarker data (neutrophil, lymphocyte, and platelet counts) obtained at admission and on postoperative day 2 and 5. RESULTS A total of 176 individuals (119 females, 57 males) were included in the study. The PLR on postoperative day 2, and NLR and SII measurement on postoperative day 2 and 5 in patients were found to have significant predictive value in 1-year mortality rates. A 1-year increase in age was associated with a 4.9% increased risk of death at 1-year follow-up (p=0.006). A 1-unit increase in NLR on postoperative day 5 was associated with a 4.3% increased risk of death at 1-year follow-up (p=0.004). CONCLUSIONS The present study shows that our model for predicting the absolute mortality risk in patients can be improved by evaluating dSII, dPLR, and dNLR in the preoperative period and postoperative day 2 and 5. However, it cannot be said that the model has a discriminatory ability to exactly predict postoperative mortality. Nevertheless, these parameters may aid in the development of early therapeutic intervention to improve patient outcomes.
Collapse
Affiliation(s)
- M M Bala
- Department of Orthopedics and Traumatology, Health Sciences University, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
| |
Collapse
|
13
|
Prokop-Dorner A, Piłat-Kobla A, Zając J, Luśtyk M, Valli C, Łapczuk A, Brzyska M, Johnston B, Zera D, Guyatt G, Alonso-Coello P, Bala MM. Values and preferences influencing willingness to change red and processed meat consumption in response to evidence-based information: a mixed methods study. Public Health Nutr 2022; 25:1-34. [PMID: 35392999 PMCID: PMC9991620 DOI: 10.1017/s1368980022000866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 04/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES (1) to assess the extent to which omnivores are willing to stop or reduce their consumption of red and processed meat in response to evidence-based information regarding the possible reduction of cancer mortality and incidence achieved by dietary modification; (2) to identify sociodemographic categories associated with higher willingness to change meat consumption; (3) to understand the motives facilitating and hindering such a change. DESIGN During an initial computer-assisted web interview, respondents were presented with scenarios containing the estimates of the absolute risk reduction in overall cancer incidence and mortality tailored to their declared level of red and processed meat consumption. Respondents were asked whether they would stop or reduce their average meat consumption based on the information provided. Their dietary choices were assessed at 6-month follow-up. Additionally, we conducted semi-structured interviews to better understand the rationale for dietary practices and the perception of health information. PARTICIPANTS The study was conducted among students and staff of 3 universities in Krakow, Poland. RESULTS Most of the 513 respondents were unwilling to change their consumption habits. We found gender to be a significant predictor of the willingness. Finally, we identified 4 themes reflecting key motives that determined meat consumption preferences: the importance of taste and texture, health consciousness, the habitual nature of cooking, and persistence of omnivorous habits. CONCLUSIONS When faced with health information about the uncertain reduction in the risk of cancer mortality and incidence, the vast majority of study participants were unwilling to introduce changes in their consumption habits.
Collapse
Affiliation(s)
- Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034Krakow, Poland
| | - Aleksandra Piłat-Kobla
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034Krakow, Poland
| | - Joanna Zając
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Michalina Luśtyk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034Krakow, Poland
| | - Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Aneta Łapczuk
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034Krakow, Poland
| | - Monika Brzyska
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-034Krakow, Poland
| | - Bradley Johnston
- College of Agriculture and Life Scinces, Texas A&M University, College Station, TX, USA
- Department of Epidemiology & Biostatistics, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Dena Zera
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
14
|
Bala MM, Bala KA. Bone mineral density (BMD) and neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) in childhood thyroid diseases. Eur Rev Med Pharmacol Sci 2022; 26:1945-1951. [PMID: 35363344 DOI: 10.26355/eurrev_202203_28342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This study aimed at investigating the laboratory parameters related to the pathogenesis of bone loss, including bone mineral density (BMD), neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) in children with thyroid disease and healthy controls. PATIENTS AND METHODS Children and adolescents with hypothyroidism (n=63) and hyperthyroidism (n=30) as well as 32 age- and sex-matched healthy controls were included in the study. Auxological data, BMD, hemogram parameters, the levels of thyroid hormone, thyroid stimulating hormone (TSH), thyroid autoantibodies, parathyroid hormone, 25-hydroxy vitamin D, alkaline phosphatase, calcium, and phosphorus were analyzed. RESULTS The mean age of the patients was 12.12±2.7 years (range: 8-17). BMD Z-scores were within the normal range in all the patients and healthy controls. The BMD Z-scores were significantly higher in patients with hyperthyroidism than those in the control group and in patients with hypothyroidism. No significant difference was observed between the control and hypothyroid groups in terms of the BMD Z-scores. A correlation was observed between the BMD Z-scores and NLR, MLR, PLR, and free T4 levels. In patients with hypothyroidism, the BMD Z-scores were significantly positively correlated with the NLR, MLR, PLR, and the TSH level. In the control group, there was a moderate positive correlation between the BMD Z-scores and NLR. In the hyperthyroid group, there were no significant correlations between the BMD Z-scores and other variables. CONCLUSIONS The study data suggest that in children and adolescents with thyroid disease, the relationship between the BMD Z-scores and NLR, MLR, and PLR at the initial diagnosis in the hypothyroidism group was different from that in their healthy peers.
Collapse
Affiliation(s)
- M M Bala
- Department of Orthopedics and Traumatology, Health Sciences University, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
| | | |
Collapse
|
15
|
Bala MM, Bala KA. Bone mineral density and complete blood count ratios in children and adolescents with obesity. Eur Rev Med Pharmacol Sci 2022; 26:249-256. [PMID: 35049002 DOI: 10.26355/eurrev_202201_27775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE Monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-high-density lipoprotein ratio (MHR), and mean platelet volume (MPV) are considered novel inflammatory markers. In this study, we aimed to investigate the relationship between bone mineral density (BMD) Z score and blood cell composition in children and adolescents with obesity and to create a suitable index for the diagnosis of obesity-associated osteoporosis. PATIENTS AND METHODS We included 148 children, comprising 112 children with obesity (obese group) and 36 sex- and age-matched healthy children (normal weight) (control group). Patient details acquired from medical records were used to measure blood count levels; BMD, using dual-energy X-ray absorptiometry; and BMD Z-scores, using race and sex specific curves. RESULTS Mean BMD Z score in the obese and normal weight group was within the normal limits and significantly higher in the obese group. The BMD Z score showed a significant relationship with MLR and PLR. Patient BMD Z-scores were negatively correlated with MLR and PLR in the obese group and positively correlated in the control group. In addition, a positive correlation was found between BMD Z score and NLR in the control group. CONCLUSIONS Our study outcomes show that there may be a relationship between bone mass and inflammation expressed as PLR and MLR in obese children and adolescents. PLR and MLR, which are common indicators of morbidity and mortality in many chronic inflammatory diseases, may also be useful for evaluating bone status in children with obesity. However, further research on the subject is warranted.
Collapse
Affiliation(s)
- M M Bala
- Department of Orthopedics and Traumatology, Health Sciences University, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
| | | |
Collapse
|
16
|
Zajac JF, Storman D, Swierz MJ, Koperny M, Weglarz P, Staskiewicz W, Gorecka M, Skuza A, Wach A, Kaluzinska K, Bochenek-Cibor J, Johnston BC, Bala MM. Are systematic reviews addressing nutrition for cancer prevention trustworthy? A systematic survey of quality and risk of bias. Nutr Rev 2021; 80:1558-1567. [PMID: 34921318 PMCID: PMC9086792 DOI: 10.1093/nutrit/nuab093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Context The last 30 years have yielded a vast number of systematic reviews and/or meta-analyses addressing the link between nutrition and cancer risk. Objective The aim of this survey was to assess overall quality and potential for risk of bias in systematic reviews and meta-analyses (SRMAs) that examined the role of nutrition in cancer prevention. Data Sources MEDLINE, Embase, and the Cochrane Library databases were searched (last search performed November 2018). Study Selection Studies identified as SRMAs that investigated a nutritional or dietary intervention or exposure for cancer prevention in the general population or in people at risk of cancer and in which primary studies had a comparison group were eligible for inclusion. Screening, data extraction, and quality assessment were conducted independently by 2 reviewers. Data Extraction Altogether, 101 studies were randomly selected for analysis. The methodological quality and risk of bias were evaluated using the AMSTAR-2 and ROBIS tools, respectively. Results Most SRMAs included observational studies. Less than 10% of SRMAs reported a study protocol, and only 51% of SRMAs assessed the risk of bias in primary studies. Most studies conducted subgroup analyses, but only a few reported tests of interaction or specified subgroups of interest a priori. Overall, according to AMSTAR-2, only 1% of SRMAs were of high quality, while 97% were of critically low quality. Only 3% had a low risk of bias, according to ROBIS. Conclusions This systematic survey revealed substantial limitations with respect to quality and risk of bias of SRMAs. SRMAs examining nutrition and cancer prevention cannot be considered trustworthy, and results should be interpreted with caution. Peer reviewers as well as users of SRMAs should be advised to use the AMSTAR-2 and/or ROBIS instruments to help to determine the overall quality and risk of bias of SRMAs. Systematic Review Registration PROSPERO registration number CRD42019121116.
Collapse
Affiliation(s)
- Joanna F Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Wach
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Kaluzinska
- Students' Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | | | - Bradley C Johnston
- Department of Nutrition and the Department of Epidemiology and Biostatistics, Texas A&M University, College Station, Texas, USA; and with the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
17
|
Swierz MJ, Storman D, Zajac J, Koperny M, Weglarz P, Staskiewicz W, Gorecka M, Skuza A, Wach A, Kaluzinska K, Bochenek-Cibor J, Johnston BC, Bala MM. Similarities, reliability and gaps in assessing the quality of conduct of systematic reviews using AMSTAR-2 and ROBIS: systematic survey of nutrition reviews. BMC Med Res Methodol 2021; 21:261. [PMID: 34837960 PMCID: PMC8627612 DOI: 10.1186/s12874-021-01457-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition. METHODS We performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116). RESULTS We found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan. CONCLUSIONS Among the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Joanna Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology Jagiellonian University Medical College , Kopernika 7 Street 31-034, Krakow, Poland
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Wach
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Kaluzinska
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | | | - Bradley C Johnston
- Departments of Nutrition, Epidemiology and Biostatistics, Texas A&M University, College Station, College Station, TX, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland.
| |
Collapse
|
18
|
Howatt V, Prokop-Dorner A, Valli C, Zajac J, Bala MM, Alonso-Coello P, Guyatt GH, Johnston BC. Values and Preferences Related to Cancer Risk among Red and Processed Meat Eaters: A Pilot Cross-Sectional Study with Semi-Structured Interviews. Foods 2021; 10:foods10092182. [PMID: 34574291 PMCID: PMC8472466 DOI: 10.3390/foods10092182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/05/2021] [Accepted: 08/16/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Over the last decade, the possible impact of meat intake on overall cancer incidence and mortality has received considerable attention, and authorities have recommended decreasing consumption; however, the benefits of reducing meat consumption are small and uncertain. As such, individual decisions to reduce consumption are value- and preference-sensitive. Consequently, we undertook a pilot cross-sectional study to explore people’s values and preferences towards meat consumption in the face of cancer risk. Methods and analysis: The mixed-method pilot study included a quantitative questionnaire followed by qualitative evaluation to explore the dietary habits of 32 meat eaters, their reasons for eating meat, and willingness to change their meat consumption when faced with a potential risk reduction of cancer over a lifetime based on a systematic review and dose–response meta-analysis. We recruited a convenience sample of participants from two Canadian provinces: Nova Scotia and Prince Edward Island. This project was approved by the Research Ethics Board for Health Sciences research at Dalhousie University, Canada. Results: The average weekly consumption of red meat was 3.4 servings and the average weekly consumption of processed meat was 3 servings. The determinants that influenced meat intake were similar for both red and processed meat. Taste, cost, and family preferences were the three most commonly cited factors impacting red meat intake. Taste, cost, and (lack of) cooking time were the three most commonly cited factors impacting processed meat intake. None of the participants were willing to eliminate red or processed meat from their diet. About half of participants were willing to potentially reduce their meat consumption, with one third definitely willing to reduce their consumption. Strengths and limitations: This study is the first that we are aware of to share data with participants on the association of red meat and processed meat consumption and the risk of cancer mortality and cancer incidence, including the certainty of evidence for the risk reduction. The limitations of this study include its small sample size and its limited geographic sampling. Conclusions: When presented explicit information about the small uncertain cancer risk associated with red and processed meat consumption, study participants were unwilling to eliminate meat, while about one-third were willing to reduce their meat intake.
Collapse
Affiliation(s)
- Victoria Howatt
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Anna Prokop-Dorner
- Chair of Epidemiology and Preventive Medicine, Department of Medical Sociology, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, 08193 Bellaterra, Spain;
- Iberoamerican Cochrane Centre Barcelona, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Epidemiology and Preventive Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Malgorzata M. Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain;
- CIBER de Epidemiología y Salud Pública (CIBERESP), 08023 Barcelona, Spain
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada;
- Department of Medicine, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Bradley C. Johnston
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Departments of Nutrition, Epidemiology and Biostatistics, Texas A&M University, College Station, TX 77843, USA
- Correspondence:
| |
Collapse
|
19
|
Vernooij R, Guyatt GH, Zeraatkar D, Han MA, Valli C, El Dib R, Alonso-Coello P, Bala MM, Johnston BC. Reconciling contrasting guideline recommendations on red and processed meat for health outcomes. J Clin Epidemiol 2021; 138:215-218. [PMID: 34273525 DOI: 10.1016/j.jclinepi.2021.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Rwm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G H Guyatt
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - D Zeraatkar
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - M A Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - C Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain; Department of Paediatrics, Obstetrics,Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona,Barcelona, Spain
| | - R El Dib
- Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil
| | - P Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - B C Johnston
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Departments of Nutrition, Epidemiology & Biostatistics, Texas A&M University, College Station, TX, USA.
| |
Collapse
|
20
|
Storman D, Swierz MJ, Riemsma RP, Wolff R, Mitus JW, Pedziwiatr M, Kleijnen J, Bala MM. Electrocoagulation for liver metastases. Cochrane Database Syst Rev 2021; 1:CD009497. [PMID: 33507555 PMCID: PMC8094173 DOI: 10.1002/14651858.cd009497.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Primary liver tumours and liver metastases from colorectal carcinoma are two of the most common malignant tumours to affect the liver. The liver is second only to the lymph nodes as the most common site for metastatic disease. More than half of the people with metastatic liver disease will die from metastatic complications. Electrocoagulation by diathermy is a method used to destroy tumour tissue, using a high-frequency electric current generating high temperatures, applied locally with an electrode (needle, blade, or ball). The objective of this method is to destroy the tumour completely, if possible, in a single session. With the time, electrocoagulation by diathermy has been replaced by other techniques, but the evidence is unclear. OBJECTIVES To assess the beneficial and harmful effects of electrocoagulation by diathermy, administered alone or with another intervention, versus no intervention, other ablation methods, or systemic treatments in people with liver metastases. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE Ovid, Embase Ovid, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index - Science, CINAHL, ClinicalTrials.gov, ICTRP, and FDA to October 2020. SELECTION CRITERIA We considered all randomised trials that assessed beneficial and harmful effects of electrocoagulation by diathermy, administered alone or with another intervention, versus comparators, in people with liver metastases, regardless of the location of the primary tumour. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed risk of bias of the included trial using predefined risk of bias domains, and presented the review results incorporating the certainty of the evidence using GRADE. MAIN RESULTS We included one randomised clinical trial with 306 participants (175 males; 131 females) who had undergone resection of the sigmoid colon, and who had five or more visible and palpable hepatic metastases. The diagnosis was confirmed by histological assessment (biopsy) and by carcinoembryonic antigen (CEA) level. The trial was conducted in Iraq. The age of participants ranged between 38 and 79 years. The participants were randomised to four different study groups. The liver metastases were biopsied and treated (only once) in three of the groups: 75 received electrocoagulation by diathermy alone, 76 received electrocoagulation plus allopurinol, 78 received electrocoagulation plus dimethyl sulphoxide. In the fourth intervention group, 77 participants functioning as controls received a vehicle solution of allopurinol 5 mL 4 x a day by mouth; the metastases were left untouched. The status of the liver and lungs was followed by ultrasound investigations, without the use of a contrast agent. Participants were followed for five years. The analyses are based on per-protocol data only analysing 223 participants. We judged the trial to be at high risk of bias. After excluding 'nonevaluable patients', the groups seemed comparable for baseline characteristics. Mortality due to disease spread at five-year follow-up was 98% in the electrocoagulation group (57/58 evaluable people); 87% in the electrocoagulation plus allopurinol group (46/53 evaluable people); 86% in the electrocoagulation plus dimethyl sulphoxide group (49/57 evaluable people); and 100% in the control group (55/55 evaluable people). We observed no difference in mortality between the electrocoagulation alone group versus the control group (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.94 to 1.03; 113 participants; very low-certainty evidence). We observed lower mortality in the electrocoagulation combined with allopurinol or dimethyl sulphoxide group versus the control group (RR 0.87, 95% CI 0.80 to 0.95; 165 participants; low-certainty evidence). We are very uncertain regarding post-operative deaths between the electrocoagulation alone group versus the control group (RR 1.03, 95% CI 0.07 to 16.12; 152 participants; very low-certainty evidence) and between the electrocoagulation combined with allopurinol or dimethyl sulphoxide groups versus the control group (RR 1.00, 95% CI 0.09 to 10.86; 231 participants; very low-certainty evidence). The trial authors did not report data on number of participants with other adverse events and complications, recurrence of liver metastases, time to progression of liver metastases, tumour response measures, and health-related quality of life. Data on failure to clear liver metastases were not provided for the control group. There was no information on funding or conflict of interest. We identified no ongoing trials. AUTHORS' CONCLUSIONS The evidence on the beneficial and harmful effects of electrocoagulation alone or in combination with allopurinol or dimethyl sulphoxide in people with liver metastases is insufficient, as it is based on one randomised clinical trial at low to very low certainty. It is very uncertain if there is a difference in all-cause mortality and post-operative mortality between electrocoagulation alone versus control. It is also uncertain if electrocoagulation in combination with allopurinol or dimethyl sulphoxide may result in a slight reduction of all-cause mortality in comparison with a vehicle solution of allopurinol (control). It is very uncertain if there is a difference in post-operative mortality between the electrocoagulation combined with allopurinol or dimethyl sulphoxide group versus control. Data on other adverse events and complications, failure to clear liver metastases or recurrence of liver metastases, time to progression of liver metastases, tumour response measures, and health-related quality of life were most lacking or insufficiently reported for analysis. Electrocoagulation by diathermy is no longer used in the described way, and this may explain the lack of further trials.
Collapse
Affiliation(s)
- Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Jerzy W Mitus
- Department of Surgical Oncology, The Maria Sklodowska-Curie Institute, Oncology Center, Krakow Branch; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Michal Pedziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
21
|
Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, Yao L, Motaghi S, Couban RJ, Ghadimi M, Bala MM, Gomaa H, Fang F, Xiao Y, Guyatt GH. Efficacité et innocuité des corticostéroïdes dans le traitement de la COVID-19 selon des données pour la COVID-19, d’autres infections aux coronavirus, l’influenza, la pneumonie extrahospitalière et le syndrome de détresse respiratoire aiguë : revue systématique et méta-analyse. CMAJ 2020; 192:E1571-E1584. [PMID: 33229355 DOI: 10.1503/cmaj.200645-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Zhikang Ye
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Ying Wang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Luis Enrique Colunga-Lozano
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Manya Prasad
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Wimonchat Tangamornsuksan
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Bram Rochwerg
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Liang Yao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Shahrzad Motaghi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Rachel J Couban
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Maryam Ghadimi
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Malgorzata M Bala
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Huda Gomaa
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Fang Fang
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Yingqi Xiao
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| | - Gordon H Guyatt
- Département de Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), Université McMaster, Hamilton, Ont.; département de pharmacie (Wang), hôpital de Chaoyang à Beijing, Capital Medical University, Beijing (Chine); département de médecine clinique (Colunga-Lozano), centre des sciences de la santé, université de Guadalajara, Guadalajara (Mexique); département de médecine Communautaire (Prasad), North DMC Medical College, New Delhi (Inde); Faculté de médecine et de santé publique (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok (Thaïlande); département de médecine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), Université McMaster, Hamilton, Ont.; département de pharmacie clinique (Ghadimi), Faculté de pharmacie, Tehran University of Medical Sciences, Téhéran (Iran); chaire d'épidémiologie et de médecine préventive (Bala), École de médecine de l'Université Jagellonne, Cracovie (Pologne); département de biostatistique (Gomaa), High institute of Public Health, Alexandria University, Alexandrie (Égypte); Centre d'information sur les médicaments (Gomaa), Tanta Chest Hospital, ministère de la Santé et des Populations, Égypte; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong (Chine); West China School of Nursing (Xiao), West China Hospital, Sichuan University (Chine)
| |
Collapse
|
22
|
Zajac JF, Szot W, Głodo P, Tobola P, Bala MM. Alpha-lipoic acid for hypertension in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd013771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Joanna F Zajac
- Systematic Reviews Unit; Jagiellonian University Medical College; Krakow Poland
| | - Wojciech Szot
- Systematic Reviews Unit; Jagiellonian University Medical College; Krakow Poland
| | - Paulina Głodo
- Systematic Reviews Unit; Jagiellonian University Medical College; Krakow Poland
| | - Paulina Tobola
- Systematic Reviews Unit; Jagiellonian University Medical College; Krakow Poland
| | - Malgorzata M Bala
- Systematic Reviews Unit; Jagiellonian University Medical College; Krakow Poland
| |
Collapse
|
23
|
Bala MM, Celinska-Lowenhoff M, Szot W, Padjas A, Kaczmarczyk M, Swierz MJ, Undas A. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev 2020; 10:CD012169. [PMID: 33045766 PMCID: PMC8094585 DOI: 10.1002/14651858.cd012169.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Antiphospholipid syndrome (APS) is a systemic autoimmune disease characterized by arterial or venous thrombosis (or both), and/or pregnancy morbidity in association with the presence of antiphospholipid antibodies. The prevalence of APS is estimated at 40 to 50 cases per 100,000 people. The most common sites of thrombosis are cerebral arteries and deep veins of the lower limbs. People with a definite APS diagnosis have an increased lifetime risk of recurrent thrombotic events. OBJECTIVES To assess the effects of antiplatelet (AP) or anticoagulant agents, or both, for the secondary prevention of recurrent thrombosis, particularly ischemic stroke, in people with APS. SEARCH METHODS We last searched the MEDLINE, Embase, CENTRAL, Cochrane Stroke Group Trials Register, and ongoing trials registers on 22 November 2019. We checked reference lists of included studies, systematic reviews, and practice guidelines. We also contacted experts in the field. SELECTION CRITERIA We included randomized controlled trials (RCTs) that evaluated any anticoagulant or AP agent, or both, in the secondary prevention of thrombosis in people with APS, according to the criteria valid when the study took place. We did not include studies specifically addressing women with obstetrical APS. DATA COLLECTION AND ANALYSIS Pairs of review authors independently worked on each step of the review, following Cochrane methods. We summarized the evidence using the GRADE approach. MAIN RESULTS We identified eight studies including 811 participants that compared different AP or anticoagulant agents. NOAC (non-VKA oral anticoagulant: rivaroxaban 15 or 20 mg/d) versus standard-dose VKA (vitamin K antagonist: warfarin at moderate International Normalized Ratio [INR] - 2.5) or adjusted [INR 2.0-3.0] dose): In three studies there were no differences in any thromboembolic event (including death) and major bleeding (moderate-certainty evidence), but an increased risk of stroke (risk ratio [RR] 14.13, 95% confidence interval [CI] 1.87 to 106.8; moderate-certainty evidence). One of the studies reported a small benefit of rivaroxaban in terms of quality of life at 180 days measured as health state on Visual Analogue Scale (mean difference [MD] 7 mm, 95% CI 2.01 to 11.99; low-certainty evidence), but not measured as health utility on a scale from 0 to 1 (MD 0.04, 95% CI -0.02 to 0.10; low-certainty evidence). High-dose VKA (warfarin with a target INR of 3.1 to 4.0 [mean 3.3] or 3.5 [mean 3.2]) versus standard-dose VKA (warfarin with a target INR of 2.0 to 3.0 [mean 2.3] or 2.5 [mean 2.5]): In two studies there were no differences in the rates of thrombotic events and major bleeding (RR 2.22, 95% CI 0.79 to 6.23, low-certainty evidence), but an increased risk of minor bleeding in one study during a mean of 3.4 years (standard deviation [SD] 1.2) of follow-up (RR 2.55, 95% CI 1.07 to 6.07). In both trials there was evidence of a higher risk of any bleeding (hazard ratio [HR] 2.03 95% CI 1.12 to 3.68; low-certainty evidence) in the high-dose VKA group, and for this outcome (any bleeding) the incidence is not different, only the time to event is showing an effect. Standard-dose VKA plus a single AP agent (warfarin at a target INR of 2.0 to 3.0 plus aspirin 100 mg/d) versus standard-dose VKA (warfarin at a target INR of 2.0 to 3.0): One high-risk-of-bias study showed an increased risk of any thromboembolic event with combined treatment (RR 2.14, 95% CI 1.04 to 4.43; low-certainty evidence) and reported on major bleeding with five cases in the combined treatment group and one case in the standard-dose VKA treatment group, resulting in RR 7.42 (95% CI 0.91 to 60.7; low-certainty evidence) and no differences for secondary outcomes (very low- to low-certainty evidence). Single/dual AP agent and standard-dose VKA (pooled results): Two high-risk-of-bias studies compared a combination of AP and VKA (aspirin 100 mg/d plus warfarin or unspecified VKA at a target INR of 2.0 to 3.0 or 2.0 to 2.5) with a single AP agent (aspirin 100 mg/d), but did not provide any conclusive evidence regarding the effects of those drugs in people with APS (very low-certainty evidence). One of the above-mentioned studies was a three-armed study that compared a combination of AP and VKA (aspirin 100 mg/d plus warfarin at a target INR of 2.0 to 2.5) with dual AP therapy (aspirin 100 mg/d plus cilostazol 200 mg/d) and dual AP therapy (aspirin 100 mg/d plus cilostazol 200 mg/d) versus a single AP treatment (aspirin 100 mg/d). This study reported on stroke (very low-certainty evidence) but did not report on any thromboembolic events, major bleeding, or any secondary outcomes. We identified two ongoing studies and three studies are awaiting classification. AUTHORS' CONCLUSIONS The evidence identified indicates that NOACs compared with standard-dose VKAs may increase the risk of stroke and do not appear to alter the risk of other outcomes (moderate-certainty evidence). Using high-dose VKA versus standard-dose VKA did not alter the risk of any thromboembolic event or major bleeding but may increase the risk of any form of bleeding (low-certainty evidence). Standard-dose VKA combined with an AP agent compared with standard-dose VKA alone may increase the risk of any thromboembolic event and does not appear to alter the risk of major bleeding or other outcomes (low-certainty evidence). The evidence is very uncertain about the benefit or harm of using standard-dose VKA plus AP agents versus single or dual AP therapy, or dual versus single AP therapy, for the secondary prevention of recurrent thrombosis in people with APS (very low-certainty evidence).
Collapse
Affiliation(s)
- Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Celinska-Lowenhoff
- 2nd Department of Internal Medicine, Department of Allergy and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szot
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Padjas
- 2nd Department of Internal Medicine, Department of Allergy and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Kaczmarczyk
- Systematic Reviews Unit - Polish Cochrane Branch, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
24
|
Swierz MJ, Storman D, Jasinska KW, Storman M, Staskiewicz W, Gorecka M, Skuza A, Tobola P, Bala MM. Systematic review and meta-analysis of perioperative behavioral lifestyle and nutritional interventions in bariatric surgery: a call for better research and reporting. Surg Obes Relat Dis 2020; 16:2088-2104. [PMID: 33036943 DOI: 10.1016/j.soard.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/02/2020] [Accepted: 08/07/2020] [Indexed: 01/08/2023]
Abstract
Bariatric surgery is considered the most effective treatment for people with morbid obesity, and certain interventions could enhance its long-term results. We searched MEDLINE, Embase, Web of Science, CENTRAL, and trial registers up to January 1, 2020. Randomized controlled trials, where behavioral lifestyle or nutritional interventions were provided perioperatively were included. Primary outcome was weight change. Two reviewers independently performed each stage of the review. Altogether 6652 references were screened. 31 studies were included for qualitative synthesis and 22 studies for quantitative synthesis. Interventions varied greatly, thus limiting possibility of synthesizing all results. Six groups of interventions were discerned, and we used standardized mean differences for synthesis. Low to very-low certainty evidence suggests that physical activity, nonvitamin nutritional interventions, vitamins, psychotherapy, and counseling but not combined interventions might bring some benefit regarding short-term postsurgery follow-ups (up to 12 mo), but the estimates varied and results were not statistically significant, except for 12 months follow-ups regarding counseling. Psychotherapy and counseling, but not vitamins and combined interventions, may provide some benefit at longer follow-ups (over 12 mo), but the certainty of evidence was low to very-low and statistically significant results were observed in comparisons including data from single studies with small sample sizes only. Included studies expressed an outcome "weight change" using 20 different measures. Misreporting of data and huge variety of outcomes do not benefit systematic analyses and may possibly lead to confusion of both researchers and readers. We suggest that authors follow a predefined set of outcomes when reporting the results of their studies. The initiative to produce "core outcome set" for clinical trials in bariatric surgery trials is currently underway.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Paulina Tobola
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.
| |
Collapse
|
25
|
Abstract
BACKGROUND Anti-neutrophilic cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) are a group of rare auto-inflammatory diseases that affects mainly small vessels. AAV includes: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Anti-cytokine targeted therapy uses biological agents capable of specifically targeting and neutralising cytokine mediators of the inflammatory response. OBJECTIVES To assess the benefits and harms of anti-cytokine targeted therapy for adults with AAV. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (2019, Issue 7), MEDLINE and Embase up to 16 August 2019. We also examined reference lists of articles, clinical trial registries, websites of regulatory agencies and contacted manufacturers. SELECTION CRITERIA Randomised controlled trials (RCTs) or controlled clinical trials of targeted anti-cytokine therapy in adults (18 years or older) with AAV compared with placebo, standard therapy or another modality and anti-cytokine therapy of different type or dose. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included four RCTs with a total of 440 participants (mean age 48 to 56 years). We analysed the studies in three groups: 1) mepolizumab (300 mg; three separate injections every four weeks for 52 weeks) versus placebo in participants with relapsing or refractory EGPA; 2) belimumab (10 mg/kg on days 0, 14, 28 and every 28 days thereafter until 12 months after the last participant was randomised) or etanercept (25 mg twice a week) with standard therapy (median 25 months) versus placebo with standard therapy (median 19 months) in participants with GPA/MPA; and 3) infliximab (3 mg/kg on days 1 and 14, before the response assessment on day 42) versus rituximab (0.375g/m2 on days 1, 8, 15 and 22) in participants with refractory GPA for up to 12 months. None of the studies were assessed as low risk of bias in all domains: one study did not report randomisation or blinding methods clearly. Three studies were at high risk and one study was at unclear risk of bias for selective outcome reporting. One trial with 136 participants with relapsing or refractory EGPA compared mepolizumab with placebo during 52 weeks of follow-up and observed one death in the mepolizumab group (1/68, 1.5%) and none in the placebo group (0/68, 0%) (Peto odds ratio (OR) 7.39, 95% confidence interval (CI) 0.15 to 372.38; low-certainty evidence). Low-certainty evidence suggests that more participants in the mepolizumab group had ≥ 24 weeks of accrued remission over 52 weeks compared to placebo (27.9% versus 2.9%; risk ratio (RR) 9.5, 95% CI 2.30 to 39.21), and durable remission within the first 24 weeks sustained until week 52 (19.1% mepolizumab versus 1.5% placebo; RR 13.0, 95% CI 1.75 to 96.63; number needed to treat for an additional beneficial outcome (NNTB) 6, 95% Cl 4 to 13). Mepolizumab probably decreases risk of relapse (55.8% versus 82.4%; RR 0.68, 95% CI 0.53 to 0.86; NNTB 4, 95% CI 3 to 9; moderate-certainty evidence). There was low-certainty evidence regarding similar frequency of adverse events (AEs): total AEs (96.9% versus 94.1%; RR 1.03, 95% CI 0.96 to 1.11), serious AEs (17.7% versus 26.5%; RR 0.67, 95% CI 0.35 to 1.28) and withdrawals due to AEs (2.9% versus 1.5%; RR 2.00, 95% CI 0.19 to 21.54). Disease flares were not measured. Based on two trials with different follow-up periods (mean of 27 months for etanercept study; up to four years for belimumab study) including people with GPA (n = 263) and a small group of participants with MPA (n = 22) analysed together, we found low-certainty evidence suggesting that adding an active drug (etanercept or belimumab) to standard therapy does not increase or reduce mortality (3.4% versus 1.4%; Peto OR 2.45, 95% CI 0.55 to 10.97). Etanercept may have little or no effect on remission (92.3% versus 89.5%; RR 0.97, 95% CI 0.89 to 1.07), durable remission (70% versus 75.3%; RR 0.93, 95% CI 0.77 to 1.11; low-certainty evidence) and disease flares (56% versus 57.1%; RR 0.98, 95% CI 0.76 to 1.27; moderate-certainty evidence). Low-certainty evidence suggests that belimumab does not increase or reduce major relapse (1.9% versus 0%; RR 2.94, 95% CI 0.12 to 70.67) or any AE (92.5% versus 82.7%; RR 1.12, 95% CI 0.97 to 1.29). Low-certainty evidence suggests a similar frequency of serious or severe AEs (47.6% versus 47.6%; RR 1.00, 95% CI 0.80 to 1.27), but more frequent withdrawals due to AEs in the active drug group (11.2%) compared to the placebo group (4.2%), RR 2.66, 95% CI 1.07 to 6.59). One trial involving 17 participants with refractory GPA compared infliximab versus rituximab added to steroids and cytotoxic agents for 12 months. One participant died in each group (Peto OR 0.88, 95% CI, 0.05 to 15.51; 11% versus 12.5%). We have very low-certainty evidence for remission (22% versus 50%, RR 0.44, 95% Cl 0.11 to 1.81) and durable remission (11% versus 50%, RR 0.22, 95% CI 0.03 to 1.60), any severe AE (22.3% versus 12.5%; RR 1.78, 95% CI 0.2 to 16.1) and withdrawals due to AEs (0% versus 0%; RR 2.70, 95% CI 0.13 to 58.24). Disease flare/relapse and the frequency of any AE were not reported. AUTHORS' CONCLUSIONS We found four studies but concerns about risk of bias and small sample sizes preclude firm conclusions. We found moderate-certainty evidence that in patients with relapsing or refractory EGPA, mepolizumab compared to placebo probably decreases disease relapse and low-certainty evidence that mepolizumab may increase the probability of accruing at least 24 weeks of disease remission. There were similar frequencies of total and serious AEs in both groups, but the study was too small to reliably assess these outcomes. Mepolizumab may result in little to no difference in mortality. However, there were very few events. In participants with GPA (and a small subgroup of participants with MPA), etanercept or belimumab may increase the probability of withdrawal due to AEs and may have little to no impact on serious AEs. Etanercept may have little or no impact on durable remission and probably does not reduce disease flare.
Collapse
Affiliation(s)
- Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa J Malecka-Massalska
- Rheumatology Department, Provincial Hospital, Radzyn Podlaski, Lublin, Poland
- Physiology Department, Medical University of Lublin, Lublin, Poland
| | - Magdalena Koperny
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna F Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Jarosław D Jarczewski
- Department of Pathophysiology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Szczeklik
- 2nd Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
26
|
Swierz MJ, Storman D, Staskiewicz W, Gorecka M, Jasinska KW, Swierz AM, Tobola P, Skuza A, Bala MM. Efficacy of probiotics in patients with morbid obesity undergoing bariatric surgery: a systematic review and meta-analysis. Surg Obes Relat Dis 2020; 16:2105-2116. [PMID: 33069600 DOI: 10.1016/j.soard.2020.08.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/27/2020] [Accepted: 08/30/2020] [Indexed: 12/15/2022]
Abstract
Bariatric surgery is considered effective for morbid obesity, and probiotic supplementation might provide some benefits. We aimed to revise the evidence regarding probiotic supplementation in patients with morbid obesity undergoing bariatric surgery. MEDLINE, Embase, Web of Science, CENTRAL, and trial registers were searched up to April 1, 2020. We included randomized controlled trials and controlled clinical trials, and outcomes of interest were weight change, quality of life, gastrointestinal symptoms, and adverse events. All stages of the review were done by 2 authors independently and we followed Cochrane Handbook guidance. We screened 2541 references and included 5 studies. Probiotics may have minor to no effect regarding percentage excess weight loss (%EWL) at 6 weeks (mean difference [MD], .28; 95% CI, -9.53 to 10.09; 44 participants, 2 studies), 3 months (MD, 5.47; 95% CI, -3.22 to 14.17; 165 participants, 3 studies), 6 months (MD, .46; 95% CI, -8.14 to 9.07; 115 participants, 2 studies), and 12 months post surgery (MD, .35; 95% CI, -8.66 to 9.37; 123 participants, 2 studies). We observed short-term improvement in gastrointestinal symptoms. There was no important effect on quality of life and no meaningful adverse events. Because probiotic supplementation might provide some benefit with respect to weight loss, might alleviate some gastrointestinal symptoms, and is associated with minor or no adverse events, continuous supplementation might be worth considering in certain individuals. Our findings are based on the body of evidence of very low certainty, and further well-designed randomized controlled trials are required to elucidate the effect and strengthen the certainty in the estimates.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | | | - Paulina Tobola
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland; Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.
| |
Collapse
|
27
|
Storman D, Bala MM, Koperny M, Zajac J, Tobola P, Swierz M, Staskiewicz W, Gorecka M, Skuza A, Johnston B. Reliability of studies published as SR/MA on nutrition in cancer prevention - a systematic survey. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In several fields of medicine, the quality of studies published as systematic reviews/meta-analyses (SR/MAs) is low. Similar problems may exist for SR/MA on nutrition in cancer prevention. We aimed to assess overall quality and risk of bias (RoB) of studies published as SR/MA on nutritional interventions in cancer prevention with two instruments: AMSTAR 2 ('a measurement tool to assess systematic review 2') and ROBIS ('Risk of Bias in Systematic Reviews') respectively.
Methods
Following a systematic search in 3 databases we included studies identified as SR/MA published between 2010 and 2018 assessing any nutritional interventions in cancer prevention in the general population or among people with cancer risk (Protocol in PROSPERO CRD42019121116). All the steps of study selection and data extraction were done by two independent reviewers with conflicts solved by discussion or by the third reviewer.
Results
We focused on a subsample of 101 SR/MA randomly selected from 737 included SR/MA. Included SR/MA on average searched 2 databases with Medline in 98% and included cohort studies (93%). They focused on specific food (36%), specific nutrients (27%) or beverages (24%, mostly tea and coffee). The assessment using AMSTAR 2 tool indicated that 93% of SR/MA had no pre-specified methodology, in 77% - research questions and inclusion criteria did not include the components of PICO, RoB assessment of primary studies was not used or did not contain all elements (87%) and RoB was not accounted for in the interpretation of the results (75%). Overall, the quality of 97% of studies was assessed as critically low. In the ROBIS tool for 97% of included studies, the overall high risk of bias was detected. The most important methodological flaws in ROBIS were similar to identified in AMSTAR tool.
Conclusions
Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers.
Key messages
Poor quality of SR/MA due to flawed methodology may lead to many concerns and mislead public media and consumers. The studies published as SR/MAs addressing nutrition for cancer prevention have major flaws, which limit the reliability of their conclusions.
Collapse
Affiliation(s)
- D Storman
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M Koperny
- Agency for Health Technology Assessment and Tariff System, Krakow, Poland
| | - J Zajac
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - P Tobola
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M Swierz
- Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - W Staskiewicz
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - M Gorecka
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - A Skuza
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - B Johnston
- Department of Nutrition, Texas A&M University, College Station, Texas, USA
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| |
Collapse
|
28
|
Storman D, Bala MM, Koperny M, Zajac J, Tobola P, Swierz M, Staskiewicz W, Gorecka M, Skuza A. Nutritional “hot topics” in studies published as SR/MA in cancer prevention between 2010 and 2018. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The number of systematic reviews and meta analysis (SR/MA) is increasing, also in the field of nutrition.
Objectives
The aim of this work was to analyse the frequency of exploring the effects of specific nutritional interventions in studies published as SR/MA focused on cancer prevention.
Methods
The main study was a systematic survey of SR/MA on nutrition in cancer prevention published between 2010 and 2018 identified through search in 3 databases. The protocol of the study was registered (CRD42019121116 in PROSPERO). All steps of the survey were done by two reviewers independently with any conflicts resolved by discussion or by the third reviewer. The quality and risk of bias were assessed using AMSTAR 2 and ROBIS tools amid subsample of 101 SR/MA. We grouped all dietetic interventions by year and analysed frequency.
Results
Among 737 SR/MA meeting the inclusion criteria, an average number of publications was 83/year ranging from 38 (in 2010) to 118 (in 2015). The most commonly studied food categories were: non-alcoholic beverages (127 publications in total; on average 14/year) and vitamins and/or minerals (157 publications in total; on average 17/ year) with coffee as one of the most popular (on average 7 SR/MA per year). The most commonly analysed vitamins were vitamin D, C, and E, while amid minerals calcium and selenium. Red meat and processed meat were comparably popular with about 4 dedicated publications every year. SR/MA about fruits and vegetables and alcohol appeared on average about 8 times every year. The overall quality of SR/MA assessed in a subsample of randomly selected 101 of included articles was poor (97% were classified as having a low quality).
Conclusions
In SR/MA published between 2010 and 2018, each food category appears many times, while for example coffee - many times every year. Detailed analysis per food item may help identify potential research waste in the field of nutrition in cancer prevention.
Key messages
Currently, coffee is the ‘hottest’ nutritional topic in cancer prevention. The general quality of SR/MA published in the field of cancer prevention is low.
Collapse
Affiliation(s)
- D Storman
- Chair of Epidemiology and Preventive Medicine, Department of, Jagiellonian University Medical College, Krakow, Poland
| | - M M Bala
- Chair of Epidemiology and Preventive Medicine, Department of, Jagiellonian University Medical College, Krakow, Poland
| | - M Koperny
- Agency for Health Technology Assessment and Tariff System, Krakow, Poland
| | - J Zajac
- Chair of Epidemiology and Preventive Medicine, Department of, Jagiellonian University Medical College, Krakow, Poland
| | - P Tobola
- Chair of Epidemiology and Preventive Medicine, Department of, Jagiellonian University Medical College, Krakow, Poland
| | - M Swierz
- Chair of Epidemiology and Preventive Medicine, Department of, Jagiellonian University Medical College, Krakow, Poland
| | - W Staskiewicz
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - M Gorecka
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - A Skuza
- Students Scientific Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
29
|
Posadzki P, Bala MM, Kyaw BM, Semwal M, Divakar U, Koperny M, Sliwka A, Car J. Correction: Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2020; 22:e20316. [PMID: 32574149 PMCID: PMC7381050 DOI: 10.2196/20316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Pawel Posadzki
- Centre for Population Health SciencesLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive MedicineDepartment of Hygiene and DieteticsJagiellonian University Medical CollegeKrakowPoland
| | - Bhone Myint Kyaw
- Family Medicine and Primary CareLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| | - Monika Semwal
- Centre for Population Health SciencesLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| | - Ushashree Divakar
- Centre for Population Health SciencesLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| | - Magdalena Koperny
- Province Sanitary-Epidemiological Station of Lesser PolandPublic Health and Health Promotion DepartmentKrakowPoland
| | - Agnieszka Sliwka
- Institute of Physiotherapy, Faculty of Health SciencesJagiellonian University Medical CollegeKrakowPoland
| | - Josip Car
- Centre for Population Health SciencesLee Kong Chian School of MedicineNanyang Technological University SingaporeSingaporeSingapore
| |
Collapse
|
30
|
Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, Yao L, Motaghi S, Couban RJ, Ghadimi M, Bala MM, Gomaa H, Fang F, Xiao Y, Guyatt GH. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2020; 192:E756-E767. [PMID: 32409522 DOI: 10.1503/cmaj.200645] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Very little direct evidence exists on use of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Indirect evidence from related conditions must therefore inform inferences regarding benefits and harms. To support a guideline for managing COVID-19, we conducted systematic reviews examining the impact of corticosteroids in COVID-19 and related severe acute respiratory illnesses. METHODS We searched standard international and Chinese biomedical literature databases and prepublication sources for randomized controlled trials (RCTs) and observational studies comparing corticosteroids versus no corticosteroids in patients with COVID-19, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). For acute respiratory distress syndrome (ARDS), influenza and community-acquired pneumonia (CAP), we updated the most recent rigorous systematic review. We conducted random-effects meta-analyses to pool relative risks and then used baseline risk in patients with COVID-19 to generate absolute effects. RESULTS In ARDS, according to 1 small cohort study in patients with COVID-19 and 7 RCTs in non-COVID-19 populations (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.55 to 0.93, mean difference 17.3% fewer; low-quality evidence), corticosteroids may reduce mortality. In patients with severe COVID-19 but without ARDS, direct evidence from 2 observational studies provided very low-quality evidence of an increase in mortality with corticosteroids (hazard ratio [HR] 2.30, 95% CI 1.00 to 5.29, mean difference 11.9% more), as did observational data from influenza studies. Observational data from SARS and MERS studies provided very low-quality evidence of a small or no reduction in mortality. Randomized controlled trials in CAP suggest that corticosteroids may reduce mortality (RR 0.70, 95% CI 0.50 to 0.98, 3.1% lower; very low-quality evidence), and may increase hyperglycemia. INTERPRETATION Corticosteroids may reduce mortality for patients with COVID-19 and ARDS. For patients with severe COVID-19 but without ARDS, evidence regarding benefit from different bodies of evidence is inconsistent and of very low quality.
Collapse
Affiliation(s)
- Zhikang Ye
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Ying Wang
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Luis Enrique Colunga-Lozano
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Manya Prasad
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Wimonchat Tangamornsuksan
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Liang Yao
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Shahrzad Motaghi
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Rachel J Couban
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Malgorzata M Bala
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Huda Gomaa
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Fang Fang
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Yingqi Xiao
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact (Ye, Tangamornsuksan, Rochwerg, Guyatt, Colunga-Lozano, Yao, Motaghi, Fang, Xiao), McMaster University, Hamilton, Ont.; Department of Pharmacy (Wang), Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; Department of Clinical Medicine (Colunga-Lozano), Health Science Center, Universidad de Guadalajara, Guadalajara, Mexico; Department of Community Medicine (Prasad), North DMC Medical College, New Delhi, India; Faculty of Medicine and Public Health (Tangamornsuksan), HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; Department of Medicine (Rochwerg); DeGroote Institute for Pain Research and Care (Couban), McMaster University, Hamilton, Ont.; Department of Clinical Pharmacy (Ghadimi), Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Chair of Epidemiology and Preventive Medicine Jagiellonian (Bala), University Medical College, Krakow, Poland; Biostatistics Department (Gomaa), High institute of Public Health, Alexandria University, Alexandria, Egypt; Drug Information Center (Gomaa), Tanta Chest Hospital, Ministry of Health and Population, Egypt; Clinical Medicine College of Acupuncture, Moxibustion and Rehabilitation (Fang), Guangzhou University of Chinese Medicine, Guangdong, China; West China School of Nursing (Xiao), West China Hospital, Sichuan University, China
| |
Collapse
|
31
|
Valli C, Howatt V, Prokop-Dorner A, Rabassa M, Johnston BC, Zajac J, Han MA, Kenji Nampo F, Guyatt GH, Bala MM, Alonso-Coello P. Evaluating adults' health-related values and preferences about unprocessed red meat and processed meat consumption: protocol for a cross-sectional mixed-methods study. F1000Res 2020; 9:346. [PMID: 34136136 PMCID: PMC8176263 DOI: 10.12688/f1000research.23593.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background: People need to choose from a wide range of foods, and in addition to availability and accessibility, people's values and preferences largely determine their daily food choices. Given the potential adverse health consequences of red and processed meat and the limited knowledge on individuals' health-related values and preferences on the topic, such data would be useful in the development of recommendations regarding meat consumption. Methods and analysis: We will perform a cross-sectional mixed methods study. The study population will consist of adult omnivores currently consuming a minimum of three weekly servings of either unprocessed red meat or processed meat. We will explore participants' willingness to stop or reduce their unprocessed red meat, or their processed meat consumption through a direct-choice exercise. This exercise will consist of presenting a scenario tailored to each individual's average weekly consumption. That is, based on a systematic review and meta-analysis of the best estimate of the risk reduction in overall cancer incidence and cancer mortality, we will ask participants if they would stop their consumption, and/or reduce their average consumption. We will also present the corresponding certainty of the evidence for the potential risk reductions. Finally, we will measure their meat consumption three months after the interview and determine if they have made any changes to their average consumption. Ethics and dissemination: The research protocol was approved by the ethics committees in Canada (Research Ethics Board, Dalhousie University), Spain (Comitè Ètic d'Investigació Clínica de l'IDIAP Jordi Gol), Poland (The Bioethics Committee of the Jagiellonian University), and Brazil (National Research Ethics Commission). The study is based on voluntary participation and informed written consent. Results from this project will be disseminated through publications and presentations.
Collapse
Affiliation(s)
- Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Victoria Howatt
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Bradley C. Johnston
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, South Korea
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Nature Sciences, Federal University of Latin-American Integration, Evidence-Based Public Health Research Group, Foz do Iguassu, Brazil
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M. Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain
| |
Collapse
|
32
|
Valli C, Howatt V, Prokop-Dorner A, Rabassa M, Johnston BC, Zajac J, Han MA, Kenji Nampo F, Guyatt GH, Bala MM, Alonso-Coello P. Evaluating adults' health-related values and preferences about unprocessed red meat and processed meat consumption: protocol for a cross-sectional mixed-methods study. F1000Res 2020; 9:346. [PMID: 34136136 PMCID: PMC8176263 DOI: 10.12688/f1000research.23593.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 04/03/2024] Open
Abstract
Background: People need to choose from a wide range of foods, and in addition to availability and accessibility, people's values and preferences largely determine their daily food choices. Given the potential adverse health consequences of red and processed meat and the limited knowledge on individuals' health-related values and preferences on the topic, such data would be useful in the development of recommendations regarding meat consumption. Methods and analysis: We will perform an international cross-sectional mixed methods study in four countries across two continents. The study population will consist of adult omnivores currently consuming a minimum of three weekly servings of either unprocessed red meat or processed meat. We will explore participants' willingness to stop or reduce their unprocessed red meat, or their processed meat consumption through a direct-choice exercise. This exercise will consist of presenting a scenario tailored to each individual's average weekly consumption. That is, based on a systematic review and meta-analysis of the best estimate of the risk reduction in overall cancer mortality and cancer incidence, we will ask participants if they would stop their consumption, and/or reduce their average consumption. We will also present the corresponding certainty of the evidence for the potential risk reductions. Finally, for all included participants, we will measure their meat consumption three months after the interview and determine if they have made any changes to their average consumption. Ethics and dissemination: The research protocol was approved by the ethics committees in Canada (Research Ethics Board, Dalhousie University), Spain (Comitè Ètic d'Investigació Clínica de l'IDIAP Jordi Gol), Poland (The Bioethics Committee of the Jagiellonian University), and Brazil (National Research Ethics Commission). The study is based on voluntary participation and informed written consent. Results from this project will be disseminated through publications and presentations.
Collapse
Affiliation(s)
- Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Victoria Howatt
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anna Prokop-Dorner
- Department of Medical Sociology, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Bradley C. Johnston
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Nutrition, Texas A&M University, College Station, Texas, USA
| | - Joanna Zajac
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, South Korea
| | - Fernando Kenji Nampo
- Latin-American Institute of Life and Nature Sciences, Federal University of Latin-American Integration, Evidence-Based Public Health Research Group, Foz do Iguassu, Brazil
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M. Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública, (CIBERESP), Barcelona, Spain
| |
Collapse
|
33
|
Schandelmaier S, Chang Y, Bala MM, Devasenapathy N, Devji T, Kwong JSW, Colunga Lozano LE, Lee Y, Agarwal A, Bhatnagar N, Ewald H, Zhang Y, Sun X, Thabane L, Walsh M, Briel M, Guyatt GH. Erratum to "A systematic survey identified 36 criteria for assessing effect modification claims in randomized trials or meta-analyses" [J Clin Epidemiol. 2019;113:159-67]. J Clin Epidemiol 2020; 123:189. [PMID: 32376118 DOI: 10.1016/j.jclinepi.2020.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Stefan Schandelmaier
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland.
| | - Yaping Chang
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Niveditha Devasenapathy
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Plot 47, Sector 44, Institutional Area, Gurgaon, 122002 Haryana, India
| | - Tahira Devji
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Joey S W Kwong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Luis E Colunga Lozano
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Yung Lee
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Michael G. DeGroote School of Medicine, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Arnav Agarwal
- Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, Ontario M5G 2C4, Canada
| | - Neera Bhatnagar
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
| | - Hannah Ewald
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland
| | - Ying Zhang
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang, Beijing 100029, China
| | - Xin Sun
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Biostatistics Unit, St Joseph's Healthcare - Hamilton, 50 Charlton Street East, Hamilton, Ontario L8N 4A6, Canada
| | - Michael Walsh
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| | - Matthias Briel
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Spitalstrasse 12, 4056 Basel, Switzerland
| | - Gordon H Guyatt
- Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada; Department of Medicine, McMaster University, 1200 Main Street West, Hamilton, Ontario L8S 4L8, Canada
| |
Collapse
|
34
|
Johnston BC, Zeraatkar D, Vernooij RWM, Rabassa M, El Dib R, Valli C, Han MA, Alonso-Coello P, Bala MM, Guyatt GH. Unprocessed Red Meat and Processed Meat Consumption. Ann Intern Med 2020; 172:639-640. [PMID: 32365371 DOI: 10.7326/l20-0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Montserrat Rabassa
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (M.R.)
| | - Regina El Dib
- Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., P.A.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., P.A.)
| | | | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| |
Collapse
|
35
|
Storman M, Storman D, Jasinska KW, Swierz MJ, Bala MM. The quality of systematic reviews/meta-analyses published in the field of bariatrics: A cross-sectional systematic survey using AMSTAR 2 and ROBIS. Obes Rev 2020; 21:e12994. [PMID: 31997545 DOI: 10.1111/obr.12994] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/24/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
Abstract
High-quality systematic reviews (SR) and meta-analyses (MA) are considered to be reliable sources of information. This study aims to assess the quality of studies published as SR or MA in the field of bariatrics in 2016 and 2017. We identified SR and MA in the field of bariatrics by searching electronic databases (MEDLINE, Embase, and Cochrane Database of Systematic Reviews). Eligible studies were those identified as SR/MA in the title/abstract, which aimed to assess any outcome in patients with morbid obesity undergoing or scheduled to undergo bariatric surgery. Two authors independently reviewed all titles and abstracts, assessed full texts of potentially eligible studies, and assessed the quality of included studies. Any discrepancies were resolved by the third reviewer. We evaluated the quality and risk of bias of each SR/MA using AMSTAR 2 checklist and ROBIS tool, respectively. Seventy-eight of 4236 references met inclusion criteria and were assessed for their quality/risk of bias. The methodological quality of 99% of all papers was classified as "critically low." A total of 6% of the studies were at low risk of bias, and 78% were assessed as being at high risk of bias. The methodological quality of studies published in 2016 and 2017 as SR/MA is highly unsatisfactory.
Collapse
Affiliation(s)
- Monika Storman
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Dawid Storman
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna W Jasinska
- Students' Research Group, Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz J Swierz
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Malgorzata M Bala
- Systematic Reviews Unit, Jagiellonian University Medical College, Krakow, Poland.,Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland.,Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
36
|
Zeraatkar D, Guyatt GH, Alonso-Coello P, Bala MM, Rabassa M, Han MA, Vernooij RWM, Valli C, El Dib R, Johnston BC. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes. Ann Intern Med 2020; 172:511-512. [PMID: 32252077 DOI: 10.7326/l20-0070] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Pablo Alonso-Coello
- Biomedical Research Institute San Pau (IIB Sant Pau) and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (P.A.)
| | | | - Montserrat Rabassa
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (M.R., C.V.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Claudia Valli
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (M.R., C.V.)
| | - Regina El Dib
- Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.D.)
| | | |
Collapse
|
37
|
Swierz MJ, Storman D, Riemsma RP, Wolff R, Mitus JW, Pedziwiatr M, Kleijnen J, Bala MM. Transarterial (chemo)embolisation versus no intervention or placebo for liver metastases. Cochrane Database Syst Rev 2020; 3:CD009498. [PMID: 32163181 PMCID: PMC7066934 DOI: 10.1002/14651858.cd009498.pub4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma or other extrahepatic primary cancers. Liver metastases are significantly more common than primary liver cancer, and long-term survival rate after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of people; therefore, other treatments have to be considered. One possible option is based on the concept that the blood supply to hepatic tumours originates predominantly from the hepatic artery. Transarterial chemoembolisation (TACE) of the hepatic artery can be achieved by administering a chemotherapeutic drug followed by vascular occlusive agents, and can lead to selective necrosis of the liver tumour while it may leave normal parenchyma virtually unaffected. This can also be performed without chemotherapy, which is called bland transarterial embolisation (TAE). OBJECTIVES To assess the beneficial and harmful effects of TAE or TACE compared with no intervention or placebo in people with liver metastases. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, and four more databases (December 2019). We also searched two trials registers and the US Food and Drug Administration database (September 2019). SELECTION CRITERIA Randomised clinical trials assessing beneficial and harmful effects of TAE or TACE compared with no intervention or placebo for liver metastases. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures. We extracted information on participant characteristics, interventions, study outcomes, study design, and trial methods. Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of evidence with GRADE. We resolved disagreements by discussion. MAIN RESULTS We included one randomised clinical trial with 61 participants (43 male and 18 female) with colorectal cancer with liver metastases: 22 received transarterial embolisation (TAE; hepatic artery embolisation), 19 received transarterial chemoembolisation (TACE; 5-fluorouracil hepatic artery infusion chemotherapy with degradable microspheres), and 20 received 'no active therapeutic intervention' as a control. Most tumours were synchronous, unresectable metastases involving up to 75% of the liver. Participants were followed for a minimum of seven months. The trial was at high risk of bias. Very-low-certainty evidence found inconclusive results for mortality at 44 months between the TAE and TACE versus no intervention groups (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.74 to 1.06; 61 participants). Local recurrence was reported in 10 participants without any details about the group allocation. Very-low-certainty evidence found little or no difference in mortality between the TAE and no intervention groups (RR 0.91, 95% CI 0.75 to 1.10; 42 participants). Median survival was 7 months from trial entry (range 2 to 44 months) in the TAE group and 7.9 months (range 1 to 26 months) in the control group, and 8.7 months after diagnosis (range 2 to 49 months) in the TAE group and 9.6 months (range 1 to 27 months) in the control group. The trial authors reported the differences were not statistically significant. There were no reported side effects in the control group. In the TAE group, 18 participants experienced short-term symptoms of 'post-embolisation syndrome', which were relieved with symptomatic treatment; one participant also had a local puncture site haematoma. Very-low-certainty evidence found little or no difference in mortality between the TACE and no intervention groups (RR 0.83, 95% CI 0.65 to 1.07; 39 participants). Median survival in the TACE group was 10.7 months (range 3 to 38 months) from trial entry, and 13.0 months (range 3 to 38 months) after diagnosis. The trial authors reported that differences between groups were not statistically significant. All participants experienced short-term nausea, with or without vomiting, immediately after treatment; one participant developed a wound infection, and one developed deep vein thrombosis. The trial did not measure failure to clear liver metastases, time to progression of liver metastases, tumour response measures, or health-related quality of life. Cancer Research Campaign, a non-profit organisation, provided a grant for the trial; Pharmacia Ltd. delivered the Port-a-Cath arterial delivery systems and degradable starch microspheres. We identified one ongoing trial comparing TACE plus chemotherapy versus chemotherapy alone in people with unresectable colorectal liver metastases who failed with first-line chemotherapy (NCT03783559). AUTHORS' CONCLUSIONS Based on one, small randomised trial at high risk of bias, the evidence is very uncertain about the effect of TAE or TACE versus no active therapeutic intervention on mortality for people with liver metastases as the true effect may be substantially different. The trial did not measure failure to clear liver metastases, time to progression of liver metastases, tumour response measures, or health-related quality of life. Short-term, minor adverse events were recorded in the intervention groups only. Large trials, following current standards of conduct and reporting, are required to explore the benefits and harms of TAE or TACE compared with no intervention or placebo in people with resectable and unresectable liver metastasis.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics; Systematic Reviews UnitKrakowPoland
| | - Dawid Storman
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics; Systematic Reviews UnitKrakowPoland
| | - Robert P Riemsma
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Robert Wolff
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Jerzy W Mitus
- The Maria Sklodowska‐Curie Institute, Oncology Center, Krakow Branch; Department of Anatomy, Jagiellonian University Medical CollegeDepartment of Surgical Oncologyul. Garncarska 11KrakowPoland31‐115
| | - Michal Pedziwiatr
- Jagiellonian University Medical College2nd Department of General SurgeryJakubowskiego Street 2KrakowMalopolskaPoland30‐688
| | - Jos Kleijnen
- School for Public Health and Primary Care (CAPHRI), Maastricht UniversityMaastrichtNetherlands6200 MD
| | - Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics; Systematic Reviews UnitKrakowPoland
| | | |
Collapse
|
38
|
Abstract
BACKGROUND The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma or other extrahepatic primary cancers. Liver metastases are significantly more common than primary liver cancer, and the reported long-term survival rate after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of patients; therefore, other treatments have to be considered. One of these is percutaneous ethanol injection (PEI), which causes dehydration and necrosis of tumour cells, accompanied by small-vessel thrombosis, leading to tumour ischaemia and destruction of the tumour. OBJECTIVES To assess the beneficial and harmful effects of percutaneous ethanol injection (PEI) compared with no intervention, other ablation methods, or systemic treatments in people with liver metastases. SEARCH METHODS We searched the following databases up to 10 September 2019: the Cochrane Hepato-Biliary Group Controlled Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library; MEDLINE Ovid; Embase Ovid; Science Citation Index Expanded; Conference Proceedings Citation Index - Science; Latin American Caribbean Health Sciences Literature (LILACS); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). We also searched clinical trials registers such as ClinicalTrials.gov, the International Clinical Trials Registry Platform (ICTRP), and the US Food and Drug Administration (FDA) (17 September 2019). SELECTION CRITERIA Randomised clinical trials assessing beneficial and harmful effects of percutaneous ethanol injection and its comparators (no intervention, other ablation methods, systemic treatments) for liver metastases. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures as outlined by Cochrane. We extracted information on participant characteristics, interventions, study outcomes, study design, and trial methods. Two review authors performed data extraction and assessed risk of bias independently. We assessed the certainty of evidence by using GRADE. We resolved disagreements by discussion. MAIN RESULTS We identified only one randomised clinical trial comparing percutaneous intratumour ethanol injection (PEI) in addition to transcatheter arterial chemoembolisation (TACE) versus TACE alone. The trial was conducted in China and included 48 trial participants with liver metastases: 25 received PEI plus TACE, and 23 received TACE alone. The trial included 37 male and 11 female participants. Mean participant age was 49.3 years. Sites of primary tumours included colon (27 cases), stomach (12 cases), pancreas (3 cases), lung (3 cases), breast (2 cases), and ovary (1 case). Seven participants had a single tumour, 15 had two tumours, and 26 had three or more tumours in the liver. The bulk diameter of the tumour on average was 3.9 cm, ranging from 1.2 cm to 7.6 cm. Participants were followed for 10 months to 43 months. The trial reported survival data after one, two, and three years. In the PEI + TACE group, 92%, 80%, and 64% of participants survived after one year, two years, and three years; in the TACE alone group, these percentages were 78.3%, 65.2%, and 47.8%, respectively. Upon conversion of these data to mortality rates, the calculated risk ratio (RR) for mortality at last follow-up when PEI plus TACE was compared with TACE alone was 0.69 (95% confidence interval (CI) 0.36 to 1.33; very low-certainty evidence) after three years of follow-up. Local recurrence was 16% in the PEI plus TACE group and 39.1% in the TACE group, resulting in an RR of 0.41 (95% CI 0.15 to 1.15; very low-certainty evidence). Forty-five out of a total of 68 tumours (66.2%) shrunk by at least 25% in the PEI plus TACE group versus 31 out of a total of 64 tumours (48.4%) in the TACE group. Trial authors reported some adverse events but provided very few details. We did not find data on time to mortality, failure to clear liver metastases, recurrence of liver metastases, health-related quality of life, or time to progression of liver metastases. The single included trial did not provide information on funding nor on conflict of interest. AUTHORS' CONCLUSIONS Evidence for the effectiveness of PEI plus TACE versus TACE in people with liver metastases is of very low certainty and is based on one small randomised clinical trial at high risk of bias. Currently, it cannot be determined whether adding PEI to TACE makes a difference in comparison to using TACE alone. Evidence for benefits or harms of PEI compared with no intervention, other ablation methods, or systemic treatments is lacking.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Jagiellonian University Medical CollegeDepartment of Hygiene and Dietetics, Systematic Reviews UnitKrakowPoland
| | - Dawid Storman
- University HospitalDepartment of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Department of Adult PsychiatryKrakowPoland
| | - Robert P Riemsma
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Robert Wolff
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Jerzy W Mitus
- The Maria Sklodowska‐Curie Institute, Oncology Center, Krakow Branch; Department of Anatomy, Jagiellonian University Medical CollegeDepartment of Surgical Oncologyul. Garncarska 11KrakowPoland31‐115
| | - Michal Pedziwiatr
- Jagiellonian University Medical College2nd Department of General SurgeryJakubowskiego Street 2KrakowMalopolskaPoland30‐688
| | - Jos Kleijnen
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
- School for Public Health and Primary Care (CAPHRI), Maastricht UniversityMaastrichtNetherlands6200 MD
| | - Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics; Systematic Reviews UnitKopernika 7KrakowPoland31‐034
| | | |
Collapse
|
39
|
Johnston BC, Alonso-Coello P, Bala MM, Zeraatkar D, Rabassa M, Valli C, Marshall C, El Dib R, Vernooij RWM, Vandvik PO, Guyatt GH. Correction to: Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): a protocol. BMC Med Res Methodol 2019; 19:240. [PMID: 31847819 PMCID: PMC6918667 DOI: 10.1186/s12874-019-0888-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the authors reported a change in the 'Competing interests' section as described below.
Collapse
Affiliation(s)
- Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Pablo Alonso-Coello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Catherine Marshall
- Cochrane Consumer and Honorary Patron of the Guidelines International Network, Wellington, New Zealand
| | - Regina El Dib
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Institute of Science and Technology, Unesp - Univ Estadual Paulista, São José dos Campos, Brazil
| | - Robin W M Vernooij
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
40
|
Wrzosek A, Jakowicka‐Wordliczek J, Zajaczkowska R, Serednicki WT, Jankowski M, Bala MM, Swierz MJ, Polak M, Wordliczek J. Perioperative restrictive versus goal-directed fluid therapy for adults undergoing major non-cardiac surgery. Cochrane Database Syst Rev 2019; 12:CD012767. [PMID: 31829446 PMCID: PMC6953415 DOI: 10.1002/14651858.cd012767.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Perioperative fluid management is a crucial element of perioperative care and has been studied extensively recently; however, 'the right amount' remains uncertain. One concept in perioperative fluid handling is goal-directed fluid therapy (GDFT), wherein fluid administration targets various continuously measured haemodynamic variables with the aim of optimizing oxygen delivery. Another recently raised concept is that perioperative restrictive fluid therapy (RFT) may be beneficial and at least as effective as GDFT, with lower cost and less resource utilization. OBJECTIVES To investigate whether RFT may be more beneficial than GDFT for adults undergoing major non-cardiac surgery. SEARCH METHODS We searched the following electronic databases on 11 October 2019: Cochrane Central Register of Controlled Trials, in the Cochrane Libary; MEDLINE; and Embase. Additionally, we performed a targeted search in Google Scholar and searched trial registries (World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov) for ongoing and unpublished trials. We scanned the reference lists and citations of included trials and any relevant systematic reviews identified. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing perioperative RFT versus GDFT for adults (aged ≥ 18 years) undergoing major non-cardiac surgery. DATA COLLECTION AND ANALYSIS Two review authors independently screened references for eligibility, extracted data, and assessed risk of bias. We resolved discrepancies by discussion and consulted a third review author if necessary. When necessary, we contacted trial authors to request additional information. We presented pooled estimates for dichotomous outcomes as risk ratios (RRs) with 95% confidence intervals (CIs), and for continuous outcomes as mean differences (MDs) with standard deviations (SDs). We used Review Manager 5 software to perform the meta-analyses. We used a fixed-effect model if we considered heterogeneity as not important; otherwise, we used a random-effects model. We used Poisson regression models to compare the average number of complications per person. MAIN RESULTS From 6396 citations, we included six studies with a total of 562 participants. Five studies were performed in participants undergoing abdominal surgery (including one study in participants undergoing cytoreductive abdominal surgery with hyperthermic intraperitoneal chemotherapy (HIPEC)), and one study was performed in participants undergoing orthopaedic surgery. In all studies, surgeries were elective. In five studies, crystalloids were used for basal infusion and colloids for boluses, and in one study, colloid was used for both basal infusion and boluses. Five studies reported the ASA (American Society of Anesthesiologists) status of participants. Most participants were ASA II (60.4%), 22.7% were ASA I, and only 16.9% were ASA III. No study participants were ASA IV. For the GDFT group, oesophageal doppler monitoring was used in three studies, uncalibrated invasive arterial pressure analysis systems in two studies, and a non-invasive arterial pressure monitoring system in one study. In all studies, GDFT optimization was conducted only intraoperatively. Only one study was at low risk of bias in all domains. The other five studies were at unclear or high risk of bias in one to three domains. RFT may have no effect on the rate of major complications compared to GDFT, but the evidence is very uncertain (RR 1.61, 95% CI 0.78 to 3.34; 484 participants; 5 studies; very low-certainty evidence). RFT may increase the risk of all-cause mortality compared to GDFT, but the evidence on this is also very uncertain (RD 0.03, 95% CI 0.00 to 0.06; 544 participants; 6 studies; very low-certainty evidence). In a post-hoc analysis using a Peto odds ratio (OR) or a Poisson regression model, the odds of all-cause mortality were 4.81 times greater with the use of RFT compared to GDFT, but the evidence again is very uncertain (Peto OR 4.81, 95% CI 1.38 to 16.84; 544 participants; 6 studies; very low-certainty evidence). Nevertheless, sensitivity analysis shows that exclusion of a study in which the final volume of fluid received intraoperatively was higher in the RFT group than in the GDFT group revealed no differences in mortality. Based on analysis of secondary outcomes, such as length of hospital stay (464 participants; 5 studies; very low-certainty evidence), surgery-related complications (364 participants; 4 studies; very low-certainty evidence), non-surgery-related complications (74 participants; 1 study; very low-certainty evidence), renal failure (410 participants; 4 studies; very low-certainty evidence), and quality of surgical recovery (74 participants; 1 study; very low-certainty evidence), GDFT may have no effect on the risk of these outcomes compared to RFT, but the evidence is very uncertain. Included studies provided no data on administration of vasopressors or inotropes to correct haemodynamic instability nor on cost of treatment. AUTHORS' CONCLUSIONS Based on very low-certainty evidence, we are uncertain whether RFT is inferior to GDFT in selected populations of adults undergoing major non-cardiac surgery. The evidence is based mainly on data from studies on abdominal surgery in a low-risk population. The evidence does not address higher-risk populations or other surgery types. Larger, higher-quality RCTs including a wider spectrum of surgery types and a wider spectrum of patient groups, including high-risk populations, are needed to determine effects of the intervention.
Collapse
Affiliation(s)
- Anna Wrzosek
- Jagiellonian University Medical CollegeDepartment of Interdisciplinary Intensive CareKrakowPoland
- University HospitalDepartment of Anaethesiology and Intensive CareKrakowPoland
| | | | - Renata Zajaczkowska
- Jagiellonian University Medical CollegeDepartment of Interdisciplinary Intensive CareKrakowPoland
| | - Wojciech T Serednicki
- Jagiellonian University Medical CollegeDepartment of Interdisciplinary Intensive CareKrakowPoland
| | - Milosz Jankowski
- University HospitalDepartment of Anaesthesiology and Intensive CareKrakowPoland
- Jagiellonian University Medical CollegeDepartment of Internal Medicine; Systematic Reviews UnitKrakowPoland
| | - Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics; Systematic Reviews UnitKopernika 7KrakowPoland31‐034
| | - Mateusz J Swierz
- Jagiellonian University Medical CollegeDepartment of Hygiene and Dietetics; Systematic Reviews UnitKrakowPoland
| | - Maciej Polak
- Jagiellonian University Medical CollegeDepartment of Epidemiology and Population Studies in the Institute of Public HealthKrakowPoland
| | - Jerzy Wordliczek
- Jagiellonian University Medical CollegeDepartment of Interdisciplinary Intensive CareKrakowPoland
| | | |
Collapse
|
41
|
Vernooij RWM, Zeraatkar D, Han MA, El Dib R, Zworth M, Milio K, Sit D, Lee Y, Gomaa H, Valli C, Swierz MJ, Chang Y, Hanna SE, Brauer PM, Sievenpiper J, de Souza R, Alonso-Coello P, Bala MM, Guyatt GH, Johnston BC. Patterns of Red and Processed Meat Consumption and Risk for Cardiometabolic and Cancer Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:732-741. [PMID: 31569217 DOI: 10.7326/m19-1583] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Studying dietary patterns may provide insights into the potential effects of red and processed meat on health outcomes. PURPOSE To evaluate the effect of dietary patterns, including different amounts of red or processed meat, on all-cause mortality, cardiometabolic outcomes, and cancer incidence and mortality. DATA SOURCES Systematic search of MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, and ProQuest Dissertations & Theses Global from inception to April 2019 with no restrictions on year or language. STUDY SELECTION Teams of 2 reviewers independently screened search results and included prospective cohort studies with 1000 or more participants that reported on the association between dietary patterns and health outcomes. DATA EXTRACTION Two reviewers independently extracted data, assessed risk of bias, and evaluated the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. DATA SYNTHESIS Eligible studies that followed patients for 2 to 34 years revealed low- to very-low-certainty evidence that dietary patterns lower in red and processed meat intake result in very small or possibly small decreases in all-cause mortality, cancer mortality and incidence, cardiovascular mortality, nonfatal coronary heart disease, fatal and nonfatal myocardial infarction, and type 2 diabetes. For all-cause, cancer, and cardiovascular mortality and incidence of some types of cancer, the total sample included more than 400 000 patients; for other outcomes, total samples included 4000 to more than 300 000 patients. LIMITATION Observational studies are prone to residual confounding, and these studies provide low- or very-low-certainty evidence according to the GRADE criteria. CONCLUSION Low- or very-low-certainty evidence suggests that dietary patterns with less red and processed meat intake may result in very small reductions in adverse cardiometabolic and cancer outcomes. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
Collapse
Affiliation(s)
- Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Regina El Dib
- Dalhousie University, Halifax, Nova Scotia, Canada, and Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Daegan Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Huda Gomaa
- Alexandria University, Alexandria, Egypt, and Tanta Chest Hospital, Ministry of Health, Tanta, Egypt (H.G.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau, Barcelona, Spain (C.V.)
| | - Mateusz J Swierz
- Jagiellonian University Medical College, Krakow, Poland (M.J.S., M.M.B.)
| | - Yaping Chang
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Steven E Hanna
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | | | - John Sievenpiper
- University of Toronto and St. Michael's Hospital, Toronto, Ontario, Canada (J.S.)
| | - Russell de Souza
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and CIBER de Epidemiología y Salud Publicá (CIBERESP), Barcelona, Spain (P.A.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (M.J.S., M.M.B.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., M.Z., K.M., Y.L., Y.C., S.E.H., R.D., G.H.G.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
| |
Collapse
|
42
|
Johnston BC, Zeraatkar D, Han MA, Vernooij RWM, Valli C, El Dib R, Marshall C, Stover PJ, Fairweather-Taitt S, Wójcik G, Bhatia F, de Souza R, Brotons C, Meerpohl JJ, Patel CJ, Djulbegovic B, Alonso-Coello P, Bala MM, Guyatt GH. Unprocessed Red Meat and Processed Meat Consumption: Dietary Guideline Recommendations From the Nutritional Recommendations (NutriRECS) Consortium. Ann Intern Med 2019; 171:756-764. [PMID: 31569235 DOI: 10.7326/m19-1621] [Citation(s) in RCA: 166] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. DESCRIPTION Dietary guideline recommendations require consideration of the certainty in the evidence, the magnitude of potential benefits and harms, and explicit consideration of people's values and preferences. A set of recommendations on red meat and processed meat consumption was developed on the basis of 5 de novo systematic reviews that considered all of these issues. METHODS The recommendations were developed by using the Nutritional Recommendations (NutriRECS) guideline development process, which includes rigorous systematic review methodology, and GRADE methods to rate the certainty of evidence for each outcome and to move from evidence to recommendations. A panel of 14 members, including 3 community members, from 7 countries voted on the final recommendations. Strict criteria limited the conflicts of interest among panel members. Considerations of environmental impact or animal welfare did not bear on the recommendations. Four systematic reviews addressed the health effects associated with red meat and processed meat consumption, and 1 systematic review addressed people's health-related values and preferences regarding meat consumption. RECOMMENDATIONS The panel suggests that adults continue current unprocessed red meat consumption (weak recommendation, low-certainty evidence). Similarly, the panel suggests adults continue current processed meat consumption (weak recommendation, low-certainty evidence). PRIMARY FUNDING SOURCE None. (PROSPERO 2017: CRD42017074074; PROSPERO 2018: CRD42018088854).
Collapse
Affiliation(s)
- Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada, McMaster University, Hamilton, Ontario, Canada, and Texas A&M University, College Station, Texas (B.C.J.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., P.A.)
| | - Regina El Dib
- Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | | | - Patrick J Stover
- Texas A&M AgriLife Research, College of Agriculture and Life Sciences, Texas A&M University, College Station, Texas (P.J.S.)
| | | | - Grzegorz Wójcik
- Jagiellonian University Medical College, Kraków, Poland (G.W., M.M.B.)
| | | | - Russell de Souza
- Population Health Research Institute, Hamilton, Ontario, Canada (R.D.)
| | - Carlos Brotons
- Sardenya Primary Health Care Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain (C.B.)
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Centre, University of Freiburg, Freiburg, Germany (J.J.M.)
| | | | | | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., P.A.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Kraków, Poland (G.W., M.M.B.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| |
Collapse
|
43
|
Zeraatkar D, Han MA, Guyatt GH, Vernooij RWM, El Dib R, Cheung K, Milio K, Zworth M, Bartoszko JJ, Valli C, Rabassa M, Lee Y, Zajac J, Prokop-Dorner A, Lo C, Bala MM, Alonso-Coello P, Hanna SE, Johnston BC. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:703-710. [PMID: 31569213 DOI: 10.7326/m19-0655] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. PURPOSE To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. DATA SOURCES EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. STUDY SELECTION Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. DATA SYNTHESIS Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. LIMITATION Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. CONCLUSION The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
Collapse
Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Jessica J Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Claudia Valli
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Montserrat Rabassa
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Joanna Zajac
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Anna Prokop-Dorner
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Calvin Lo
- University of British Columbia, Vancouver, British Columbia, Canada (C.L.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Pablo Alonso-Coello
- Biomedical Research Institute San Pau (IIB Sant Pau) and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (P.A.)
| | - Steven E Hanna
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
| |
Collapse
|
44
|
Han MA, Zeraatkar D, Guyatt GH, Vernooij RWM, El Dib R, Zhang Y, Algarni A, Leung G, Storman D, Valli C, Rabassa M, Rehman N, Parvizian MK, Zworth M, Bartoszko JJ, Lopes LC, Sit D, Bala MM, Alonso-Coello P, Johnston BC. Reduction of Red and Processed Meat Intake and Cancer Mortality and Incidence: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:711-720. [PMID: 31569214 DOI: 10.7326/m19-0699] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Cancer incidence has continuously increased over the past few centuries and represents a major health burden worldwide. PURPOSE To evaluate the possible causal relationship between intake of red and processed meat and cancer mortality and incidence. DATA SOURCES Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019 without language restrictions. STUDY SELECTION Cohort studies that included more than 1000 adults and reported the association between consumption of unprocessed red and processed meat and cancer mortality and incidence. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed risk of bias; 1 reviewer evaluated the certainty of evidence, which was confirmed or revised by the senior reviewer. DATA SYNTHESIS Of 118 articles (56 cohorts) with more than 6 million participants, 73 articles were eligible for the dose-response meta-analyses, 30 addressed cancer mortality, and 80 reported cancer incidence. Low-certainty evidence suggested that an intake reduction of 3 servings of unprocessed meat per week was associated with a very small reduction in overall cancer mortality over a lifetime. Evidence of low to very low certainty suggested that each intake reduction of 3 servings of processed meat per week was associated with very small decreases in overall cancer mortality over a lifetime; prostate cancer mortality; and incidence of esophageal, colorectal, and breast cancer. LIMITATION Limited causal inferences due to residual confounding in observational studies, risk of bias due to limitations in diet assessment and adjustment for confounders, recall bias in dietary assessment, and insufficient data for planned subgroup analyses. CONCLUSION The possible absolute effects of red and processed meat consumption on cancer mortality and incidence are very small, and the certainty of evidence is low to very low. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
Collapse
Affiliation(s)
- Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Robin W M Vernooij
- Dalhousie University, Halifax, Nova Scotia, Canada, and Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (R.W.V.)
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | - Ying Zhang
- Beijing University of Chinese Medicine, Beijing, China (Y.Z.)
| | | | - Gareth Leung
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Dawid Storman
- Jagiellonian University Medical College, Kraków, Poland (D.S.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (C.V., M.R.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (C.V., M.R.)
| | - Nadia Rehman
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Michael K Parvizian
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Jessica J Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | | | - Daegan Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | | | - Pablo Alonso-Coello
- McMaster University, Hamilton, Ontario, Canada, and Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (P.A.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
| |
Collapse
|
45
|
Zeraatkar D, Johnston BC, Bartoszko J, Cheung K, Bala MM, Valli C, Rabassa M, Sit D, Milio K, Sadeghirad B, Agarwal A, Zea AM, Lee Y, Han MA, Vernooij RWM, Alonso-Coello P, Guyatt GH, El Dib R. Effect of Lower Versus Higher Red Meat Intake on Cardiometabolic and Cancer Outcomes: A Systematic Review of Randomized Trials. Ann Intern Med 2019; 171:721-731. [PMID: 31569236 DOI: 10.7326/m19-0622] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Few randomized trials have evaluated the effect of reducing red meat intake on clinically important outcomes. PURPOSE To summarize the effect of lower versus higher red meat intake on the incidence of cardiometabolic and cancer outcomes in adults. DATA SOURCES EMBASE, CENTRAL, CINAHL, Web of Science, and ProQuest from inception to July 2018 and MEDLINE from inception to April 2019, without language restrictions. STUDY SELECTION Randomized trials (published in any language) comparing diets lower in red meat with diets higher in red meat that differed by a gradient of at least 1 serving per week for 6 months or more. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed the risk of bias and the certainty of the evidence. DATA SYNTHESIS Of 12 eligible trials, a single trial enrolling 48 835 women provided the most credible, though still low-certainty, evidence that diets lower in red meat may have little or no effect on all-cause mortality (hazard ratio [HR], 0.99 [95% CI, 0.95 to 1.03]), cardiovascular mortality (HR, 0.98 [CI, 0.91 to 1.06]), and cardiovascular disease (HR, 0.99 [CI, 0.94 to 1.05]). That trial also provided low- to very-low-certainty evidence that diets lower in red meat may have little or no effect on total cancer mortality (HR, 0.95 [CI, 0.89 to 1.01]) and the incidence of cancer, including colorectal cancer (HR, 1.04 [CI, 0.90 to 1.20]) and breast cancer (HR, 0.97 [0.90 to 1.04]). LIMITATIONS There were few trials, most addressing only surrogate outcomes, with heterogeneous comparators and small gradients in red meat consumption between lower versus higher intake groups. CONCLUSION Low- to very-low-certainty evidence suggests that diets restricted in red meat may have little or no effect on major cardiometabolic outcomes and cancer mortality and incidence. PRIMARY FUNDING SOURCE None (PROSPERO: CRD42017074074).
Collapse
Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Bradley C Johnston
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Jessica Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | | | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Daegen Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Behnam Sadeghirad
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Arnav Agarwal
- University of Toronto, Toronto, Ontario, Canada (A.A.)
| | - Adriana M Zea
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R., P.A.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., B.C.J., J.B., K.C., K.M., B.S., A.M.Z., Y.L., G.H.G.)
| | - Regina El Dib
- Institute of Science and Technology, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil (R.E.)
| |
Collapse
|
46
|
Valli C, Rabassa M, Johnston BC, Kuijpers R, Prokop-Dorner A, Zajac J, Storman D, Storman M, Bala MM, Solà I, Zeraatkar D, Han MA, Vernooij RWM, Guyatt GH, Alonso-Coello P. Health-Related Values and Preferences Regarding Meat Consumption: A Mixed-Methods Systematic Review. Ann Intern Med 2019; 171:742-755. [PMID: 31569219 DOI: 10.7326/m19-1326] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND A person's meat consumption is often determined by their values and preferences. PURPOSE To identify and evaluate evidence addressing health-related values and preferences regarding meat consumption. DATA SOURCES MEDLINE, EMBASE, Web of Science, Centre for Agriculture and Biosciences Abstracts, International System for Agricultural Science and Technology, and Food Science and Technology Abstracts were searched from inception to July 2018 without language restrictions. STUDY SELECTION Pairs of reviewers independently screened search results and included quantitative and qualitative studies reporting adults' health-related values and preferences regarding meat consumption. DATA EXTRACTION Pairs of reviewers independently extracted data and assessed risk of bias. DATA SYNTHESIS Data were synthesized into narrative form, and summaries were tabulated and certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Of 19 172 initial citations, 41 quantitative studies (38 addressed reasons for meat consumption and 5 addressed willingness to reduce meat consumption) and 13 qualitative studies (10 addressed reasons for meat consumption and 4 addressed willingness to reduce meat consumption) were eligible for inclusion. Thirteen studies reported that omnivores enjoy eating meat, 18 reported that these persons consider meat an essential component of a healthy diet, and 7 reported that they believe they lack the skills needed to prepare satisfactory meals without meat. Omnivores are generally unwilling to change their meat consumption. The certainty of evidence was low for both "reasons for meat consumption" and "willingness to reduce meat consumption in the face of undesirable health effects." LIMITATION Limited generalizability of findings to lower-income countries, low-certainty evidence for willingness to reduce meat consumption, and limited applicability to specific types of meat (red and processed meat). CONCLUSION Low-certainty evidence suggests that omnivores are attached to meat and are unwilling to change this behavior when faced with potentially undesirable health effects. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42018088854).
Collapse
Affiliation(s)
- Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Auto` noma de Barcelona, Barcelona, Spain (C.V.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (M.R.)
| | - Bradley C Johnston
- McMaster University, Hamilton, Ontario, and Dalhousie University, Halifax, Nova Scotia, Canada (B.C.J.)
| | - Ruben Kuijpers
- Wageningen University, Wageningen, the Netherlands (R.K.)
| | - Anna Prokop-Dorner
- Jagiellonian University Medical College, Krakow, Poland (A.P., J.Z., D.S., M.M.B.)
| | - Joanna Zajac
- Jagiellonian University Medical College, Krakow, Poland (A.P., J.Z., D.S., M.M.B.)
| | - Dawid Storman
- Jagiellonian University Medical College, Krakow, Poland (A.P., J.Z., D.S., M.M.B.)
| | - Monika Storman
- Medical University of Warsaw, Warsaw, and Jagiellonian University Medical College, Krakow, Poland (M.S.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (A.P., J.Z., D.S., M.M.B.)
| | - Ivan Solà
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (I.S.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Mi Ah Han
- School of Medicine, Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Robin W M Vernooij
- Dalhousie University, Halifax, Nova Scotia, Canada, and Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands (R.W.V.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G.)
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain, and McMaster University, Hamilton, Ontario, Canada (P.A.)
| | | |
Collapse
|
47
|
Abstract
BACKGROUND The liver is affected by two of the most common groups of malignant tumours: primary liver tumours and liver metastases from colorectal carcinoma. Liver metastases are significantly more common than primary liver cancer and long-term survival rates reported for patients after radical surgical treatment is approximately 50%. However, R0 resection (resection for cure) is not feasible in the majority of patients. Cryotherapy is performed with the use of an image-guided cryoprobe which delivers liquid nitrogen or argon gas to the tumour tissue. The subsequent process of freezing is associated with formation of ice crystals, which directly damage exposed tissue, including cancer cells. OBJECTIVES To assess the beneficial and harmful effects of cryotherapy compared with no intervention, other ablation methods, or systemic treatments in people with liver metastases. SEARCH METHODS We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Embase Ovid, and six other databases up to June 2018. SELECTION CRITERIA Randomised clinical trials assessing beneficial and harmful effects of cryotherapy and its comparators for liver metastases, irrespective of the location of the primary tumour. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We extracted information on participant characteristics, interventions, study outcomes, and data on the outcomes important for our review, as well as information on the design and methodology of the trials. Two review authors independently assessed risk of bias in each study. One review author performed data extraction and a second review author checked entries. MAIN RESULTS We found no randomised clinical trials comparing cryotherapy versus no intervention or versus systemic treatments; however, we identified one randomised clinical trial comparing cryotherapy with conventional surgery. The trial was conducted in Ukraine. The trial included 123 participants with solitary, or multiple unilobar or bilobar liver metastases; 63 participants received cryotherapy and 60 received conventional surgery. There were 36 women and 87 men. The primary sites for the metastases were colon and rectum (66.6%), stomach (7.3%), breast (6.5%), skin (4.9%), ovaries (4.1%), uterus (3.3%), kidney (3.3%), intestines (1.6%), pancreas (1.6%), and unknown (0.8%). The trial was not reported sufficiently enough to assess the risk of bias of the randomisation process, allocation concealment, or presence of blinding. It was also not possible to assess incomplete outcome data and selective outcome reporting bias. The certainty of evidence was low because of risk of bias and imprecision.The participants were followed for up to 10 years (minimum five months). The trial reported that the mortality at 10 years was 81% (51/63) in the cryotherapy group and 92% (55/60) in the conventional surgery group. The calculated by us relative risk (RR) with 95% Confidence Interval (CI) was: RR 0.88, 95% CI 0.77 to 1.02. We judged the evidence as low-certainty evidence. Regarding adverse events and complications, separately and in total, our calculation showed no evidence of a difference in recurrence of the malignancy in the liver: 86% (54/63) of the participants in the cryotherapy group and 95% (57/60) of the participants in the conventional surgery group developed a new malignancy (RR 0.90, 95% CI 0.80 to 1.01; low-certainty evidence). The frequency of reported complications was similar between the cryotherapy group and the conventional surgery group, except for postoperative pain. Both insignificant and pronounced pain were reported to be more common in the cryotherapy group while intense pain was reported to be more common in the conventional surgery group. However, the authors did not report whether there was any evidence of a difference. There were no intervention-related mortality or bile leakages.We identified no evidence for health-related quality of life, cancer mortality, or time to progression of liver metastases. The study reported tumour response in terms of the carcinoembryonic antigen level in 69% of participants, and reported results in the form of a graph for 30% of participants. The carcinoembryonic antigen level was lower in the cryotherapy group, and decreased to normal values faster in comparison with the control group (P < 0.05). FUNDING the trial did not provide information on funding. AUTHORS' CONCLUSIONS The evidence for the effectiveness of cryotherapy versus conventional surgery in people with liver metastases is of low certainty. We are uncertain about our estimate and cannot determine whether cryotherapy compared with conventional surgery is beneficial or harmful. We found no evidence for the benefits or harms of cryotherapy compared with no intervention, or versus systemic treatments.
Collapse
Affiliation(s)
- Malgorzata M Bala
- Jagiellonian University Medical CollegeChair of Epidemiology and Preventive Medicine; Department of Hygiene and Dietetics; Systematic Reviews UnitKopernika 7KrakowPoland31‐034
| | - Robert P Riemsma
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Robert Wolff
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
| | - Michal Pedziwiatr
- Jagiellonian University Medical College2nd Department of General SurgeryKopernika Street 21KrakówMalopolskaPoland31‐501
| | - Jerzy W Mitus
- Centre of Oncology, Maria Skłodowska – Curie Memorial Institute, Krakow Branch. Department of Anatomy, Jagiellonian University Medical College Krakow, PolandDepartment of Surgical Oncologyul. Garncarska 11KrakowPoland31‐115
| | - Dawid Storman
- University HospitalDepartment of Hygiene and Dietetics, Systematic Reviews Unit, Jagiellonian University Medical College, Department of Adult PsychiatryKrakowPoland
| | - Mateusz J Swierz
- Jagiellonian University Medical CollegeDepartment of Hygiene and Dietetics, Systematic Reviews UnitKrakowPoland
| | - Jos Kleijnen
- Kleijnen Systematic Reviews LtdUnit 6, Escrick Business ParkRiccall Road, EscrickYorkUKYO19 6FD
- School for Public Health and Primary Care (CAPHRI), Maastricht UniversityMaastrichtNetherlands6200 MD
| | | |
Collapse
|
48
|
Posadzki P, Bala MM, Kyaw BM, Semwal M, Divakar U, Koperny M, Sliwka A, Car J. Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12968. [PMID: 31017584 PMCID: PMC6505374 DOI: 10.2196/12968] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 01/21/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Abstract
Background The shortage and disproportionate distribution of health care workers worldwide is further aggravated by the inadequacy of training programs, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment. Offline digital education has the potential to improve the quality of health professions education. Objective The primary objective of this systematic review was to evaluate the effectiveness of offline digital education compared with various controls in improving learners’ knowledge, skills, attitudes, satisfaction, and patient-related outcomes. The secondary objectives were (1) to assess the cost-effectiveness of the interventions and (2) to assess adverse effects of the interventions on patients and learners. Methods We searched 7 electronic databases and 2 trial registries for randomized controlled trials published between January 1990 and August 2017. We used Cochrane systematic review methods. Results A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (standardized mean difference [SMD]=1.88; 95% CI 1.14 to 2.62; participants=300; studies=3; I2=80%; low certainty evidence). A meta-analysis of 2 studies found that compared with no intervention, the effects of offline digital education (computer-assisted training [CAT]) on nurses and physical therapists’ knowledge were uncertain (SMD 0.55; 95% CI –0.39 to 1.50; participants=64; I2=71%; very low certainty evidence). A meta-analysis of 2 studies found that compared with traditional learning, a PowerPoint presentation may improve the knowledge of patient care personnel and pharmacists (SMD 0.76; 95% CI 0.29 to 1.23; participants=167; I2=54%; low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, the effects of computer-assisted training on skills in community (mental health) therapists, nurses, and pharmacists were uncertain (SMD 0.45; 95% CI –0.35 to 1.25; participants=229; I2=88%; very low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses and mental health therapists (SMD –0.07; 95% CI –0.42 to 0.28, participants=232; I2=41%; low certainty evidence). A total of 2 studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes, the results were mixed and inconclusive. None of the studies reported adverse or unintended effects of the interventions. Only 1 study reported costs of interventions. The risk of bias was predominantly unclear and the certainty of the evidence ranged from low to very low. Conclusions There is some evidence to support the effectiveness of offline digital education in improving learners’ knowledge and insufficient quality and quantity evidence for the other outcomes. Future high-quality studies are needed to increase generalizability and inform use of this modality of education.
Collapse
Affiliation(s)
- Pawel Posadzki
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Bhone Myint Kyaw
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Monika Semwal
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ushashree Divakar
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Magdalena Koperny
- Province Sanitary-Epidemiological Station of Lesser Poland, Public Health and Health Promotion Department, Krakow, Poland
| | - Agnieszka Sliwka
- Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| |
Collapse
|
49
|
Busse JW, Wang L, Kamaleldin M, Craigie S, Riva JJ, Montoya L, Mulla SM, Lopes LC, Vogel N, Chen E, Kirmayr K, De Oliveira K, Olivieri L, Kaushal A, Chaparro LE, Oyberman I, Agarwal A, Couban R, Tsoi L, Lam T, Vandvik PO, Hsu S, Bala MM, Schandelmaier S, Scheidecker A, Ebrahim S, Ashoorion V, Rehman Y, Hong PJ, Ross S, Johnston BC, Kunz R, Sun X, Buckley N, Sessler DI, Guyatt GH. Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA 2018; 320:2448-2460. [PMID: 30561481 PMCID: PMC6583638 DOI: 10.1001/jama.2018.18472] [Citation(s) in RCA: 397] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
IMPORTANCE Harms and benefits of opioids for chronic noncancer pain remain unclear. OBJECTIVE To systematically review randomized clinical trials (RCTs) of opioids for chronic noncancer pain. DATA SOURCES AND STUDY SELECTION The databases of CENTRAL, CINAHL, EMBASE, MEDLINE, AMED, and PsycINFO were searched from inception to April 2018 for RCTs of opioids for chronic noncancer pain vs any nonopioid control. DATA EXTRACTION AND SYNTHESIS Paired reviewers independently extracted data. The analyses used random-effects models and the Grading of Recommendations Assessment, Development and Evaluation to rate the quality of the evidence. MAIN OUTCOMES AND MEASURES The primary outcomes were pain intensity (score range, 0-10 cm on a visual analog scale for pain; lower is better and the minimally important difference [MID] is 1 cm), physical functioning (score range, 0-100 points on the 36-item Short Form physical component score [SF-36 PCS]; higher is better and the MID is 5 points), and incidence of vomiting. RESULTS Ninety-six RCTs including 26 169 participants (61% female; median age, 58 years [interquartile range, 51-61 years]) were included. Of the included studies, there were 25 trials of neuropathic pain, 32 trials of nociceptive pain, 33 trials of central sensitization (pain present in the absence of tissue damage), and 6 trials of mixed types of pain. Compared with placebo, opioid use was associated with reduced pain (weighted mean difference [WMD], -0.69 cm [95% CI, -0.82 to -0.56 cm] on a 10-cm visual analog scale for pain; modeled risk difference for achieving the MID, 11.9% [95% CI, 9.7% to 14.1%]), improved physical functioning (WMD, 2.04 points [95% CI, 1.41 to 2.68 points] on the 100-point SF-36 PCS; modeled risk difference for achieving the MID, 8.5% [95% CI, 5.9% to 11.2%]), and increased vomiting (5.9% with opioids vs 2.3% with placebo for trials that excluded patients with adverse events during a run-in period). Low- to moderate-quality evidence suggested similar associations of opioids with improvements in pain and physical functioning compared with nonsteroidal anti-inflammatory drugs (pain: WMD, -0.60 cm [95% CI, -1.54 to 0.34 cm]; physical functioning: WMD, -0.90 points [95% CI, -2.69 to 0.89 points]), tricyclic antidepressants (pain: WMD, -0.13 cm [95% CI, -0.99 to 0.74 cm]; physical functioning: WMD, -5.31 points [95% CI, -13.77 to 3.14 points]), and anticonvulsants (pain: WMD, -0.90 cm [95% CI, -1.65 to -0.14 cm]; physical functioning: WMD, 0.45 points [95% CI, -5.77 to 6.66 points]). CONCLUSIONS AND RELEVANCE In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.
Collapse
Affiliation(s)
- Jason W. Busse
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu
| | | | - Samantha Craigie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - John J. Riva
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Luis Montoya
- Krembil Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Sohail M. Mulla
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Now with the Canadian Agency for Drugs and Technologies in Health (CADTH), Toronto, Ontario, Canada
| | - Luciane C. Lopes
- Pharmaceutical Science, University of Sorocaba, Sao Paulo, Brazil
| | - Nicole Vogel
- Leonardo Hirslanden Klinik Birshof, Münchenstein, Switzerland
| | - Eric Chen
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karin Kirmayr
- Department of Internal Medicine, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Kyle De Oliveira
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lori Olivieri
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alka Kaushal
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Luis E. Chaparro
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Inna Oyberman
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Ludwig Tsoi
- Accident and Emergency Department, Queen Mary Hospital, Pokfulam, Hong Kong, China
| | - Tommy Lam
- Accident and Emergency Department, Tuen Mun Hospital, Hong Kong, China
| | - Per Olav Vandvik
- Department of Medicine, Gjøvik, Innlandet Hospital Trust, Norway
| | - Sandy Hsu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M. Bala
- Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Stefan Schandelmaier
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Institute for Clinical Epidemiology and Biostatistics, University of Basel Hospital, Basel, Switzerland
- Department of Clinical Research, University of Basel Hospital, Basel, Switzerland
| | - Anne Scheidecker
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University of Basel Hospital, Basel, Switzerland
| | - Shanil Ebrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Vahid Ashoorion
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Isfahan Medical Education Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yasir Rehman
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Canadian Academy of Osteopathy, Hamilton, Ontario, Canada
| | - Patrick J. Hong
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Ross
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bradley C. Johnston
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Regina Kunz
- Department of Clinical Research, University of Basel Hospital, Basel, Switzerland
| | - Xin Sun
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Chinese Cochrane Centre, West China Hospital, Sichuan University, Chengdu
| | - Norman Buckley
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Daniel I. Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
50
|
Johnston BC, Alonso-Coello P, Bala MM, Zeraatkar D, Rabassa M, Valli C, Marshall C, El Dib R, Vernooij RWM, Vandvik PO, Guyatt GH. Methods for trustworthy nutritional recommendations NutriRECS (Nutritional Recommendations and accessible Evidence summaries Composed of Systematic reviews): a protocol. BMC Med Res Methodol 2018; 18:162. [PMID: 30518328 PMCID: PMC6280455 DOI: 10.1186/s12874-018-0621-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 11/16/2018] [Indexed: 12/14/2022] Open
Abstract
Background Recent systematic reviews and editorials suggest that many organizations that produce nutritional guideline recommendations do not adhere to internationally recognized standards set forth by the Institute of Medicine (IoM), Guidelines International Network (GIN), Appraisal of Guidelines Research and Evaluation (AGREE), and Grading Recommendations, Assessment, Development and Evaluation (GRADE). Methods The potential solution is an independent group with content expertise and skilled in the methodology of systematic reviews and practice guidelines to produce trustworthy guideline recommendations, recommendations that are supported by publication in a top tier journal. The BMJ Rapid Recommendations project has recently demonstrated the feasibility and utility of this approach. Here, we are proposing trustworthy nutritional guideline recommendations based on internationally accepted guideline development standards, recommendations that will be informed by rigorous and novel systematic reviews of the benefits and harms associated with nutritional exposures, as well as studies on the values and preferences related to dietary behaviors among members of the international community. Discussion Adhering to international guideline standards, conducting high quality systematic reviews, and actively assessing the values and preferences of key stakeholders is expected to improve the quality of nutritional guidelines and their relevance to end-users, particularly patients and community members. We will send our work for peer review, and if found acceptable, we will publish our nutritional recommendations in top-tier general medicine journals.
Collapse
Affiliation(s)
- Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada. .,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
| | - Pablo Alonso-Coello
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Krakow, Poland
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Catherine Marshall
- Cochrane Consumer and Honorary Patron of the Guidelines International Network, Wellington, New Zealand
| | - Regina El Dib
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Institute of Science and Technology, Unesp - Univ Estadual Paulista, São José dos Campos, Brazil
| | - Robin W M Vernooij
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Per O Vandvik
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Medicine, Innlandet Hospital Trust-division, Gjøvik, Norway
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Department of Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|