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Conducting high‐quality overviews of reviews (OoR) is time‐consuming. Because the quality of systematic reviews (SRs) varies, it is necessary to critically appraise SRs when conducting an OoR. A well‐established appraisal tool is A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, which takes about 15–32 min per application. To save time, we developed two fast‐and‐frugal decision trees (FFTs) for assessing the methodological quality of SR for OoR either during the full‐text screening stage (Screening FFT) or to the resulting pool of SRs (Rapid Appraisal FFT). To build a data set for developing the FFT, we identified published AMSTAR 2 appraisals. Overall confidence ratings of the AMSTAR 2 were used as a criterion and the 16 items as cues. One thousand five hundred and nineteen appraisals were obtained from 24 publications and divided into training and test data sets. The resulting Screening FFT consists of three items and correctly identifies all non‐critically low‐quality SRs (sensitivity of 100%), but has a positive predictive value of 59%. The three‐item Rapid Appraisal FFT correctly identifies 80% of the high‐quality SRs and correctly identifies 97% of the low‐quality SRs, resulting in an accuracy of 95%. The FFTs require about 10% of the 16 AMSTAR 2 items. The Screening FFT may be applied during full‐text screening to exclude SRs with critically low quality. The Rapid Appraisal FFT may be applied to the final SR pool to identify SR that might be of high methodological quality. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Registration Impact Reporting Method Patient or Public Contribution The aim of this study is to combine and compare results from systematic reviews reporting the content and effect of programmes for the introduction of newly graduated nurses employed in hospital settings on increasing retention and decreasing turnover.An umbrella review.The electronic databases of PubMed/MEDLINE, CINAHL and PhycInfo were searched in January 2023 for eligible systematic reviews. The search string consisted of keywords extracted from the PICOS inclusion criteria. The AMSTAR 2 instrument was used for critical appraisal of the methodological quality of the eligible systematic reviews. The process and results of the review were presented using a narrative description of the data.Five systematic reviews, reporting 84 intervention studies evaluating nine types of introduction programmes from 2001 to 2018, were included in the umbrella review. All nine programme types were executed by nurses in a preceptor or mentor role and the content was directed towards training of the preceptor/mentor and introduction of the newly graduated nurses. The nine programmes showed overall positive effects on retention and turnover.Mentorship and Preceptorship were the most frequently evaluated programmes in the included intervention studies of the five reviews. However, the lack of transparency of the reviews and the bias of the intervention studies within the reviews, made it difficult to conclude specific effects of the content of the nine programmes.The protocol for the umbrella review is registered with Open Science Framework (https://OSF.IO/DXYS4).A weak introduction to hospital employment of newly graduated nurses may decrease retention and increase turnover. Structured and personal introduction by a mentor can have an effect on the newly graduated nurses' intentions to stay in their hospital care position.AMSTAR 2.None. [ABSTRACT FROM AUTHOR]

Abstract The objective of this umbrella review was to investigate comprehensive and synthesized evidence of the association between ambient air pollution and obesity based on the current systematic reviews and meta-analyses. Related studies from databases including PubMed, EMBASE, Web of Science, and the Cochrane Library, published before July 16, 2023, were considered in the analysis. All selected systematic reviews and meta-analyses were included in accordance with PRISMA guidelines. The risk of bias and the methodological quality were evaluated using the AMSTAR 2 tool. The protocol for this umbrella review was documented in PROSPERO with the registration number: CRD42023450191. This umbrella review identified 7 studies, including 5 meta-analyses and 2 systematic reviews, to assess the impacts of air pollutants on obesity. Commonly examined air pollutants included PM1, PM2.5, PM10, NO2, SO2, O3. Most of the included studies presented that air pollution exposure was positively associated with the increased risk of obesity. The impact of air pollution on obesity varied by different ambient air pollutants. This study provided compelling evidence that exposure to air pollution had a positive association with the risk of obesity. These findings further indicate the importance of strengthening air pollution prevention and control. Future studies should elucidate the possible mechanisms and pathways linking air pollution to obesity.

Background: Many systematic reviews (SRs) have reported the efficacy of acupuncture in improving Parkinson's disease (PD), but the quality of evidence is unknown. Therefore, it is necessary to comprehensively summarize and objectively evaluate the evidence of acupuncture for PD. Methods: Seven databases were searched to retrieve SRs on the acupuncture for PD. Two reviewers independently completed literature retrieval, screening, and data extraction. The methodological quality, risk of bias (RoB), evidence quality of the included SRs were assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2), the Risk of Bias in Systematic Reviews (ROBIS), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. Results: A total of 24 SRs were included. According to AMSTAR 2, 6 (25%) were rated as high quality, 6 (25%) were rated as moderate quality, and 12 (50%) were rated as very low quality. The application of the ROBIS tool showed that 12 (25%) SRs were at low risk of bias. The results of GRADE showed that 8 (7.62%) outcomes provided high quality evidence, 23 (21.9%) outcomes provided moderate quality evidence, 42 (40%) outcomes provided low quality evidence, and 32 (30.48%) outcomes provided very low quality evidence. Conclusion: The overview indicates that acupuncture shows promise as a treatment for PD, although the evidence is limited and inconclusive due to methodological flaws and the heterogeneity of existing studies. Future research should focus on fully reporting methodological details and following review guidelines to produce more reliable and consistent evidence on the effectiveness of acupuncture for PD. [ABSTRACT FROM AUTHOR]

The objective of this umbrella review was to investigate comprehensive and synthesized evidence of the association between ambient air pollution and obesity based on the current systematic reviews and meta-analyses. Related studies from databases including PubMed, EMBASE, Web of Science, and the Cochrane Library, published before July 16, 2023, were considered in the analysis. All selected systematic reviews and meta-analyses were included in accordance with PRISMA guidelines. The risk of bias and the methodological quality were evaluated using the AMSTAR 2 tool. The protocol for this umbrella review was documented in PROSPERO with the registration number: CRD42023450191. This umbrella review identified 7 studies, including 5 meta-analyses and 2 systematic reviews, to assess the impacts of air pollutants on obesity. Commonly examined air pollutants included PM1, PM2.5, PM10, NO2, SO2, O3. Most of the included studies presented that air pollution exposure was positively associated with the increased risk of obesity. The impact of air pollution on obesity varied by different ambient air pollutants. This study provided compelling evidence that exposure to air pollution had a positive association with the risk of obesity. These findings further indicate the importance of strengthening air pollution prevention and control. Future studies should elucidate the possible mechanisms and pathways linking air pollution to obesity. [ABSTRACT FROM AUTHOR]

Systematic reviews (SRs) have an important role in the healthcare decision-making practice. Assessing the overall confidence in the results of SRs using quality assessment tools, such as “A MeaSurement Tool to Assess Systematic Reviews 2” (AMSTAR 2), is crucial since not all SRs are conducted using the most rigorous methods. In this article, we introduce a free, open-source R package called “amstar2Vis” (https://github.com/bougioukas/amstar2Vis) that provides easy-to-use functions for presenting the critical appraisal of SRs, based on the items of AMSTAR 2 checklist. An illustrative example is outlined, describing the steps involved in creating a detailed table with the item ratings and the overall confidence ratings, generating a stacked bar plot that shows the distribution of ratings as percentages of SRs for each AMSTAR 2 item, and creating a “ggplot2” graph that shows the distribution of overall confidence ratings (“Critically Low,” “Low,” “Moderate,” or “High”). We expect “amstar2Vis” to be useful for overview authors and methodologists who assess the quality of SRs with AMSTAR 2 checklist and facilitate the production of pertinent publication-ready tables and figures. Future research and applications could further investigate the functionality or potential improvements of our package. [ABSTRACT FROM AUTHOR]

Background: To evaluate the current evidence on clear aligners and root resorption using 3D and/or combined 2D and 3D methods from available systematic reviews and meta-analyses and to determine the relationship between root resorption and clear aligners using the AMSTAR 2 tool. Methods: A comprehensive literature search of systematic reviews investigating aligners and root resorption, published up until 31 December 2022, was conducted. The following electronic databases were searched: MEDLINE via PubMed, EMBASE, Google Scholar, Science Direct, Web of Science, Scopus, LIVIVO, and LILACS. There were no language restrictions. The inclusion criteria were restricted to studies focusing on root resorption utilizing either 3D methods exclusively or a combination of 2D and 3D techniques. Data were screened and analyzed for quality using the "A Measurement Tool to Assess Systematic Reviews (AMSTAR 2)" tool. Data extraction was conducted independently by two authors. The gathered information was categorized and synthesized narratively based on the primary findings elucidated within the reviews. Results: Out of a total of 1221 potentially eligible studies initially identified, 4 systematic reviews met the inclusion criteria following the exclusion of irrelevant studies. Among these, two systematic reviews (50%) were classified as low-quality, while the remaining two (50%) were deemed to be of critically low quality. Conclusions: Based on the findings of four systematic reviews, the root resorption rate was lower with the use of clear aligners than with fixed aligners. It is advisable to approach the interpretation of this conclusion with caution, as the quality of the available evidence is assessed to be very low. Higher quality systematic reviews are needed to substantiate this conclusion. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews (SRs) worldwide suffer from methodological deficiencies, potentially biasing intervention decisions, and Peruvian SRs are no exception. Evaluating SRs led by Peruvian researchers is a crucial step to enhance quality and transparency in decision-making and to identify topics where SRs are either scarce or prioritized for research. Objective: To describe the characteristics and assess the methodological quality of SRs with Peruvian first authors. Methods: We conducted a scoping review within the Scopus database on January 5, 2023. We aimed to identify published SRs of interventions in which the first author had a Peruvian affiliation, published between 2013 and 2022. We evaluated the methodological quality of these SRs using the AMSTAR 2 tool. We assessed the factors associated with the AMSTAR 2 score using adjusted mean differences (aMD), including their 95 % confidence intervals (95 % CI). Results: We identified 95 eligible SRs, with a clear upward trend. SRs were primarily published in Q1 (43.2 %) and Q2 (23.2 %) journals, predominantly affiliated with institutions in Lima (90.5 %). Areas like infectious diseases (20.0 %) and dentistry (18.9 %) were most frequent. AMSTAR 2 assessments highlighted deficiencies, with few SRs reporting prior protocols (37.9 %), comprehensive search strategies (23.2 %), explanations for excluded studies (20.0 %), adequate descriptions of included studies (38.3 %), or funding sources (19.1 %). Notably, SRs in Q4 journals (aMD: −19.7, 95 % CI: −33.8 to −5.5) and those on surgical interventions (aMD: −22.6, 95 % CI: −34.7 to −10.4) had lower AMSTAR 2 scores. Conclusions: Although Peruvian-led SRs are increasingly being published, critical deficiencies are common, especially in reporting protocols, search strategies, study descriptions, and funding sources. Addressing these gaps is pivotal for enhancing the credibility and utility of these SRs in informing decision-making.

This study aimed to assess the methods and outcomes of The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisals in overviews of reviews (overviews) of interventions in the cardiovascular field and identify factors that are associated with these outcomes. MEDLINE, Scopus, and the Cochrane Database of Systematic Reviews were searched until November 2022. Eligible were overviews of cardiovascular interventions, analyzing systematic reviews (SRs) of randomized controlled trials (RCTs). Extracted data included characteristics of overviews and SRs and AMSTAR 2 appraisal methods and outcomes. Data were synthesized using descriptive statistics and logistic regression to explore potential associations between the characteristics of SRs and extracted AMSTAR 2 overall ratings ("High‐Moderate" vs. "Low‐Critically low"). The original results on individual AMSTAR 2 items were entered into the official AMSTAR 2 online tool and the recalculated overall confidence ratings were compared to those provided in overviews. All 34 overviews identified were published between 2019 and 2022. Rating of overall confidence following the algorithm suggested by AMSTAR 2 developers was noted in 74% of overviews. The 679 unique included SRs were mainly of "Critically low" (53%) or "Low" (18.7%) confidence and underperformed in items 2 (Protocol, no = 65.2%) and 7 (List of excluded studies, no = 84%). The following characteristics of SRs were significantly associated with higher overall ratings: Cochrane origin, pharmacological interventions, including exclusively RCTs, citation of methodological and reporting guidelines, protocol, absence of funding and publication after AMSTAR 2 release. Generally, overviews' authors tended to deviate from the original rating scheme and ascribe higher ratings to SRs compared to the official AMSTAR 2 online tool. Most SRs included in overviews of cardiovascular interventions have critically low or low confidence in their results. Overviews' authors should be more transparent about the methods used to derive the overall confidence in SRs. [ABSTRACT FROM AUTHOR]

To identify the contexts in which goal setting has been used in chronic disease management interventions and to estimate the magnitude of its effect on improvement of health outcomes. The strength of evidence and extent of potential bias in the published systematic reviews of goal setting interventions in chronic conditions were summarized using AMSTAR2 quality appraisal tool, number of participants, 95% prediction intervals, and between-study heterogeneity. Components of goal setting interventions were also extracted. Nine publications and 35 meta-analysis models were identified, investigating 25 health outcomes. Of the 35 meta-analyses, none found strong evidence and three provided some suggestive evidence on symptom reduction and perceived well-being. There was weak evidence for effects on eight health outcomes (HbA1c, self-efficacy, depression, anxiety, distress, medication adherence, health-related quality of life and physical activity), with the rest classified as non-significant. Half of the meta-analyses had high level of heterogeneity. Goal setting by itself affects outcomes of chronic diseases only to a small degree. This is not unexpected finding as changing outcomes in chronic diseases requires a complex and individualized approach. Implementing goal setting in a standardized way in the management of chronic conditions would seem to be a way forward. The link between goal setting and health outcomes seems to be weak. Some levels of positive behavioural change could be of benefits to patients as seen by improved self-efficacy, patients' satisfaction and overall quality of life. Systematic and consistent application of personalized goal-oriented interventions considering patient's readiness to change could better predict improved outcomes. Incorporation of various goal setting components while actively engaging patient and/or their care givers in the process could appraise how goal setting could help with challenges in faced by people living with chronic conditions in different areas. [ABSTRACT FROM AUTHOR]

Background: Indocyanine green (ICG) is an injectable fluorochrome that has recently gained popularity as a means of assisting intraoperative visualization during laparoscopic and robotic surgery. Many systematic reviews and meta-analyses have been published. We conducted a meta-review to synthesize the findings of these studies. Methods: PubMed and Embase were searched to identify systematic reviews and meta-analyses coping with the uses of ICG in abdominal operations, including Metabolic Bariatric Surgery, Cholecystectomy, Colorectal, Esophageal, Gastric, Hepato-Pancreato-Biliary, Obstetrics and Gynecology (OG), Pediatric Surgery, Surgical Oncology, Urology, (abdominal) Vascular Surgery, Adrenal and Splenic Surgery, and Interdisciplinary tasks, until September 2023. We submitted the retrieved meta-analyses to qualitative analysis based on the AMSTAR 2 instrument. Results: We identified 116 studies, 41 systematic reviews (SRs) and 75 meta-analyses (MAs), spanning 2013–2023. The most thoroughly investigated (sub)specialties were Colorectal (6 SRs, 25 MAs), OG (9 SRs, 15 MAs), and HPB (4 SRs, 12 MAs). Interestingly, there was high heterogeneity regarding the administered ICG doses, routes, and timing. The use of ICG offered a clear benefit regarding anastomotic leak prevention, particularly after colorectal and esophageal surgery. There was no clear benefit regarding sentinel node detection after OG. According to the AMSTAR 2 tool, most meta-analyses ranked as "critically low" (34.7%) or "low" (58.7%) quality. There were only five meta-analyses (6.7%) that qualified as "moderate" quality, whereas there were no "high" quality reviews. Conclusions: Regardless of the abundance of pertinent literature and reviews, surgeons should be cautious when interpreting their results on ICG use in abdominal surgery. Future reviews should focus on ensuring methodological vigor; establishing clear protocols of ICG dose, route of administration, and timing; and improving reporting quality. Other sources of data (e.g., registries) and novel methods of data analysis (e.g., machine learning) might also contribute to an enhanced role of ICG as a decision-making tool in surgery. [ABSTRACT FROM AUTHOR]

Background/Aims: High methodological quality is required to interpret results of systematic reviews (SRs) in a reliable and accurate manner. The primary aim of this study was to appraise the methodologic quality of SRs with meta‐analysis within the field of traumatic dental injuries using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool and assess overall confidence in their results. A secondary aim was to identify potential predictive factors associated with methodological quality. Materials and Methods: SRs with meta‐analyses published in English in the field of traumatic dental injuries from inception to March 2023 were identified. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist. Two independent evaluators scored each AMSTAR 2 item as "yes" if it was adequately addressed, "partial yes" if it was partially addressed, and "no" if it was not addressed. The overall confidence in the results of each review was classified as "High," "Moderate," "Low," or "Critically low." Using multiple regression, the relationship between five predictor variables (journal impact factor, year of publication, number of authors, journal adherence to Preferred Reporting Items for Systematic reviews and Meta‐analyses [PRISMA] guidelines and a priori protocol registration) and the total AMSTAR 2 scores was analyzed. The p‐value was 5%. Results: Forty‐one SRs were included. The overall confidence in the results of 13 reviews was categorized as "Critically low," 18 as "Low," 3 as "Moderate" and 7 as "High." Among the five predictor variables analyzed statistically, impact factor of the journal and year of publication significantly influenced the total AMSTAR 2 scores. The number of authors, adherence to PRISMA guidelines, and a priori protocol registration had no significant impact on AMSTAR 2 scores. Conclusion: The overall confidence in the results of SRs with meta‐analysis within the field of traumatic dental injuries was "Low" or "Critically Low" in the vast majority of studies (31 of 41). SRs with meta‐analyses published in journals with higher impact factors and more recent publications had significantly higher methodological quality. [ABSTRACT FROM AUTHOR]

Background Worldwide, breast cancer has become the most common malignancy, and many breast cancer survivors struggle with psychological problems in treatment and recovery. The efficacy of mindfulness-based stress reduction (MBSR) in the psychological care of breast cancer patients has been confirmed in many systematic reviews (SRs) . However, due to inconsistent outcome measures used in various SRs, the review results cannot be directly applied to clinical practice. Objective To perform an overview of the SRs of the efficacy of MBSR in breast cancer patients, providing a reference for the making of psychological care interventions for these patients. Methods PubMed, Embase, Cochrane Library, Web of Science, CINAHL, PsycINFO, JBI, CNKI, Wanfang Data, and CBM were searched from inception to July 2022 for SRs of patients with breast cancer treated with MBSR. Literature screening and data extraction were performed by two researchers independently. Methodological quality was assessed using the AMSTAR 2. The standardization of reporting quality was assessed using the PRISMA checklist. Quality of evidence and strength of recommendations were assessed using the GRADE approach. The confidence of evidence from qualitative SRs was assessed using the CERQual. Results Fourteen SRs were included. The methodological quality of included SRs was generally low, with only one being of high quality and two fatally missing key items. The defects in reporting quality were mainly in study protocol registration, risk of bias assessment and funding sources. Fifteen outcomes and 73 evidence bodies (0, 31, 28 and 6 were classified as high, moderate, low, and very low quality, respectively, by the GRADE approach, and the other 8 were classified as low quality by the CERQual approach) were identified in the SRs in total. MBSR could relieve anxiety, depression, fatigue, and stress in breast cancer patients to varying degrees, whose efficacy has proven to be significant in a short-term, but is uncertain in a long-term. Conclusion Generally, SRs on MBSR improving psychological condition in breast cancer patients contain unsatisfactory quality of evidence, whose methodological quality and standardization level of reporting quality still need to be improved further. Moreover, the shorter-term effect of MBSR has been confirmed, but its long-term effect is uncertain, and requires to be evaluated by more high-quality, large-sample clinical studies.

Purpose of Review: This overview aims to reevaluate the methodological quality, report quality, and evidence quality of systematic reviews (SRs)/meta-analyses (MAs) of acupuncture for low back pain to determine whether acupuncture effectively treats low back pain (LBP). Recent Findings: Twenty-three SRs/MAs were deemed eligible for the present overview. The AMSTAR 2 score showed that the methodological quality of one SR/MA was of medium quality, one was of low quality, and 21 were of critically low quality. Based on the results of the PRISMA evaluation, there are certain areas for improvement in the quality of reporting of SRs/MAs. There were some reporting flaws in the topic of search strategy (8/23, 34.78%), certainty assessment (4/23, 17.39%), the certainty of evidence (4/23, 17.39%), registration and protocol (3/23, 13.04%), and availability of data, code, and other material (1/23, 4.35%). Results from the GRADE evaluation indicated that 13 of 255 outcomes were rated as moderate, 88 were low, and 154 were very low. Summary: Acupuncture effectively treated LBP in the SRs/MAs included in the reevaluation. However, the methodological, report, and evidence-based quality of the SRs/MAs on acupuncture for LBP was low. Therefore, further rigorous and comprehensive studies are warranted to improve the quality of SRs/MAs in this field. [ABSTRACT FROM AUTHOR]

Background: Antibiotics alter the microbial balance commonly resulting in antibiotic-associated diarrhea (AAD). Probiotics may prevent and treat AAD by providing the gut barrier and restoring the gut microflora. This study will overview the Systematic Reviews (SRs) of probiotics in preventing and treating AAD in children. It will also assess the reporting, methodological, and evidence quality of the included SRs to provide evidence for their clinical practice. Methods: After searching PubMed, Embase, Cochrane Library, CNKI, CBM, VIP, and WanFang Data databases, and finally included SRs of probiotics in the prevention and treatment of AAD in children, which were published before 1 October 2022. The reporting, methodological, and evidence quality of the included SRs were assessed by PRISMA 2020 statement, AMSTAR 2 tool, and GRADE system. Results: A total of 20 SRs were included, and the results of PRISMA 2020 showed that 4 out of 20 SRs with relatively complete reporting, and the others within some reporting deficiencies, with scores ranging from 17 points to 26.5 points; the results of AMSTAR 2 showed that 3 SRs belonged to moderate quality level, 10 SRs belonged to low-quality level and 7 SRs being extremely low-quality level; the results of the GRADE system showed that a total of 47 outcomes were reported for the included SRs, three were high-level evidence quality, 16 were medium-level evidence quality, 24 were low-level evidence quality, and four were extremely low-level evidence quality; the results of the Meta-analysis showed that high doses (5–40 billion CFUs per day) of probiotics had a significant effect in the prevention of AAD, but it is too early to conclude the effectiveness and safety of other probiotic drugs for AAD in children, except for Lacticaseibacillus rhamnosus and Saccharomyces boulardii. Conclusion: Current evidence shows that probiotics effectively prevent and treat AAD in children, and the effect of probiotics on pediatric AAD may be a potential dose-response effect. However, the conclusion should be treated with caution due to deficiencies in the methodological, reporting, and evidence quality of the included SRs. Therefore, the methodological, reporting, and evidence quality of relevant SRs still need further improvement. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES:Although most people have some experience as caregivers, the nature and context of care are highly variable. Caregiving, socioeconomic factors, and health are all interrelated. For these reasons, caregiver interventions must consider these factors. This review examines the degree to which caregiver intervention research has reported and considered social determinants of health. RESEARCH DESIGN AND METHODS:We examined published systematic reviews and meta-analyses of interventions for older adults with age-related chronic conditions using the PRISMA and AMSTAR 2 checklists. From 2,707 papers meeting search criteria, we identified 197 potentially relevant systematic reviews, and selected 33 for the final analysis. RESULTS:We found scant information on the inclusion of social determinants; the papers lacked specificity regarding race/ethnicity, gender, sexual identity, socioeconomic status, and geographic location. The majority of studies focused on dementia, with other conditions common in later life vastly underrepresented. DISCUSSION AND IMPLICATIONS:Significant gaps in evidence persist, particularly for interventions targeting diverse conditions and populations. To advance health equity and improve the effectiveness of interventions, research should address caregiver heterogeneity and improve assessment, support, and instruction for diverse populations. Research must identify aspects of heterogeneity that matter in intervention design, while recognizing opportunities for common elements and strategies.

Abstract Background ‘A Measurement Tool to Assess Systematic Reviews, version 2’ (AMSTAR 2) is a validated 16-item scale designed to appraise systematic reviews (SRs) of healthcare interventions and to rate the overall confidence in their results. This commentary aims to describe the challenges with rating of the individual items and the application of AMSTAR 2 from the user perspective. Discussion A group of six experienced users (methodologists working in different clinical fields for at least 10 years) identified and discussed the challenges in rating of each item and the general use of AMSTAR 2 to appraise SRs. A group discussion was used to develop recommendations on how users could deal with the identified challenges. We identified various challenges with the content of items 2–16 and with the derivation of the overall confidence ratings on AMSTAR 2. These challenges include the need (1) to provide additional definitions (e.g., what constitutes major deviations from SR protocol on item 2), (2) to choose a rating strategy for multiple conditions on single items (e.g., how to rate item 5 if studies were selected in duplicate, but consensus between two authors was not reported), and (3) to determine rules for deriving the confidence ratings (e.g., what items are critical for such ratings). Based on these challenges we formulated specific recommendations for items 2–16 that AMSTAR 2 users could consider before applying the tool. Summary Our commentary adds to the existing literature by providing the first in-depth examination of the AMSTAR 2 tool from the user perspective. The identified challenges could be addressed by additional decision rules including definitions for ambiguous items and guidance for rating of complex items and derivation of confidence ratings. We recommend that a team consensus regarding such decision rules is required before appraisal procedure begins. Trial registration Not applicable.

Background Stroke is one of the leading causes of death and disability worldwide. The incidence of aphasia resulting from first-ever ischemic stroke is about 30%. Current guideline-recommended therapy is often challenging to achieve a satisfactory outcome, but numerous studies have shown that the treatment benefit could be increased if acupuncture therapy is used in a combined approach. Objective To give an overview of systematic reviews/meta-analyses of acupuncture-based treatment for post-stroke aphasia (PSA) . Methods Systematic reviews/meta-analyses of the efficacy of acupuncture-based treatment in PSA were searched in databases of CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed and EMBase from inception to July 2021. Literature enrollment and data extraction were performed by two researchers, respectively. The AMSTAR 2, PRISMA statement, and GRADE classification were used to evaluate methodological quality, the quality of reporting and the quality of evidence for outcome indicators, respectively. The results of overview were analysed in a comprehensive manner. Results A total of 12 systematic reviews/meta-analyses were included. One was of moderate methodological quality, five were of low quality and six were of critically low. Mainly due to the absence of a description of the pre-design protocol, the quality of majority of studies was rated low or critically low. The 12 studies had PRISMA scores ranging from 17 to 25, 7 of which with scores of 20-25 were considered relatively complete, and 5 with scores of 17-19 were considered to have certain defects. Fifty-four pieces of evidence were summarized from the studies, 12 of which were rated as moderate by GRADE in terms of quality, 24 were rated as low, and 18 very low. Conclusion In accordance with the evidence of moderate quality, compared with speech rehabilitation alone, acupuncture with speech rehabilitation could better improve the speech impairment, auditory comprehension, repetition and reading ability, and acupuncture-based treatment could better improve the overall clinical response in patients with PSA, so acupuncture therapy is recommended for clinical use. However, the efficacy of acupuncture in PSA is needs to be verified further by clinical evidence derived from more high-quality original studies using a strict evidence development process.

Abstract Background Systematic reviews (SRs) provide the highest level of evidence and inform evidence-based decision making in health care. Earlier studies found association with industry to be negatively associated with methodological quality of SRs. However, this has not been investigated in SRs on vaccines. Methods We performed a systematic literature search using MEDLINE and EMBASE in March 2020. The results were restricted to those published between 2016 and 2019 with no language restrictions. Study characteristics were extracted by one person and checked by an experienced reviewer. The methodological quality of the SRs was assessed with the AMSTAR 2 tool by multiple reviewers after a calibration exercise was performed. A summary score for each SR was calculated. The Mann-Whitney U test and Fisher’s exact test were performed to compare both groups. Results Out of 185 SRs that met all inclusion criteria, 27 SRs were industry funded. Those were matched with 30 non-industry funded SRs resulting in a total sample size of 57. The mean AMSTAR 2 summary score across all SRs was 0.49. Overall, the median AMSTAR 2 summary score was higher for the non-industry funded SRs than for the industry-funded SRs (0.62 vs. 0.36; p < .00001). Lower ratings for industry funded SRs were consistent across all but one AMSTAR 2 item, though significantly lower only for three specific items. Conclusion The methodological quality of SRs in vaccination is comparable to SRs in other fields, while it is still suboptimal. We are not able to provide a satisfactory explanation why industry funded SRs had a lower methodological quality than non-industry funded SRs over recent years. Industry funding is an important indicator of methodological quality for vaccine SRs and should be carefully considered when appraising SR quality.

Abstract Background The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be “high,” “moderate,” “low,” or “critically low.” Results Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of “critically low quality” and two were of “low quality.” These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2’s rating rules.

Relevance. Determining the quality of a systematic review is known to be of the main criteria to consider when making a clinical decision. And various assessment tools allow you to determine this, both for the readers themselves and for those who write a systematic review. Aim. In this study we investigate characteristics of the AMSTAR 2 assessment tool to determine the methodological quality of systematic reviews of intervention research, as well as validated the Russian version of this questionnaire. Materials and methods. We used an adapted Russian version of AMSTAR 2 (our own translation) to conduct a descriptive study of systematic reviews which were made in the Russian language. The search for Russian-language studies was carried out in the electronic scientific library named «eLibrary», by keywords and their combinations, without chronological restrictions. The selection of publications (total 10) was carried out randomly. After that, the methodological quality was assessed independently by three authors. The agreement of expert assessments was measured by calculating the coefficient kappa according to the J. Fleiss’ method. Under the null hypothesis H0 we meant kappa equaled 0, that is, the observed agreement between the reviewers is tantamount to random agreement. When testing statistical hypotheses, p < 0.05 was used. Statistical analysis was carried out in R 4.1.2 (RStudio 1.1.463), using the kappaGUI and irr packages. Results. We have translated the AMSTAR 2 questionnaire (16 signalling questions) into Russian, as well as made terminological and methodological additions to it. The preliminary analysis showed that our Russian-language version of this evaluation tool allows us to properly assess the methodological quality of systematic reviews and meta-analyses, their potential value for consumers of evidence-based information regarding the effectiveness of medical interventions. Conclusion. The AMSTAR 2 methodology allows critical evaluation of systematic reviews not only of randomized controlled clinical trials, but of non-randomized trials. The extended functionality of the questionnaire, in particular its Russian version, makes it possible to unambiguously determine the correctness of the methodology for writing a systematic review and meta-analysis, which will help in finding a high-quality review and control at the writing stage.

Background: Systematic literature reviews (SLRs) have become a standard practice as part of software engineering (SE) research, although their quality varies. To build on the reviews, both for future research and industry practice, they need to be of high quality. Aim: To assess the quality of SLRs in SE, we put forward an appraisal instrument for SLRs. Method: A well-established appraisal instrument from research in healthcare was used as a starting point to develop the instrument. It is adapted to SE using guidelines, checklists, and experiences from SE. The first version was reviewed by four external experts on SLRs in SE and updated based on their feedback. To demonstrate its use, the updated version was also used by the authors to assess a sample of six selected systematic literature studies. Results: The outcome of the research is an appraisal instrument for quality assessment of SLRs in SE. The instrument includes 15 items with different options to capture the quality. The instrument also supports consolidating the items into groups, which are then used to assess the overall quality of an SLR. Conclusion: The presented instrument may be helpful support for an appraiser in assessing the quality of SLRs in SE.

Background: 'A Measurement Tool to Assess Systematic Reviews, version 2' (AMSTAR 2) is a validated 16-item scale designed to appraise systematic reviews (SRs) of healthcare interventions and to rate the overall confidence in their results. This commentary aims to describe the challenges with rating of the individual items and the application of AMSTAR 2 from the user perspective. Discussion: A group of six experienced users (methodologists working in different clinical fields for at least 10 years) identified and discussed the challenges in rating of each item and the general use of AMSTAR 2 to appraise SRs. A group discussion was used to develop recommendations on how users could deal with the identified challenges. We identified various challenges with the content of items 2–16 and with the derivation of the overall confidence ratings on AMSTAR 2. These challenges include the need (1) to provide additional definitions (e.g., what constitutes major deviations from SR protocol on item 2), (2) to choose a rating strategy for multiple conditions on single items (e.g., how to rate item 5 if studies were selected in duplicate, but consensus between two authors was not reported), and (3) to determine rules for deriving the confidence ratings (e.g., what items are critical for such ratings). Based on these challenges we formulated specific recommendations for items 2–16 that AMSTAR 2 users could consider before applying the tool. Summary: Our commentary adds to the existing literature by providing the first in-depth examination of the AMSTAR 2 tool from the user perspective. The identified challenges could be addressed by additional decision rules including definitions for ambiguous items and guidance for rating of complex items and derivation of confidence ratings. We recommend that a team consensus regarding such decision rules is required before appraisal procedure begins. Trial registration: Not applicable. [ABSTRACT FROM AUTHOR]

Background: Systematic literature reviews (SLRs) have become a standard practice as part of software engineering (SE) research, although their quality varies. To build on the reviews, both for future research and industry practice, they need to be of high quality. Aim: To assess the quality of SLRs in SE, we put forward an appraisal instrument for SLRs. Method: A well-established appraisal instrument from research in healthcare was used as a starting point to develop the instrument. It is adapted to SE using guidelines, checklists, and experiences from SE. The first version was reviewed by four external experts on SLRs in SE and updated based on their feedback. To demonstrate its use, the updated version was also used by the authors to assess a sample of six selected systematic literature studies. Results: The outcome of the research is an appraisal instrument for quality assessment of SLRs in SE. The instrument includes 15 items with different options to capture the quality. The instrument also supports consolidating the items into groups, which are then used to assess the overall quality of an SLR. Conclusion: The presented instrument may be helpful support for an appraiser in assessing the quality of SLRs in SE. [ABSTRACT FROM AUTHOR]

Background Telerehabilitation (TR) is an emerging model of rehabilitation service delivery based on communication technology, remote sensing and control technology, virtual reality technology and computer technology to to achieve cross-regional rehabilitation medical services. However, the effectiveness of TR in functional rehabilitation after stroke is still unclear, the methodological quality of related studies is uneven, and few researchers have systematically evaluated it. Objective To re-evaluate the systematic reviews/meta-analyses on the effectiveness of TR for functional rehabilitation after stroke. Methods In August 2021, PubMed, Web of science, the Cochrane Library, VIP, WanFang Data, CNKI and CBM were retrieved by computer for systematic reviews/meta-analyses on the effectiveness of TR applied to functional rehabilitation after stroke from the establishment of the database to August 2021. After the literature screen and data extract by two researchers independently, the methodological quality of the included literature was evaluated by AMSTAR 2 scale, and the evidence quality of the outcome index was graded by GRADE system. Descriptive analysis was used to analyze the effectiveness of TR in functional rehabilitation after stroke. Results A total of 10 systematic reviews/meta-analyses were included, and the results of the AMSTAR 2 review showed that 2 systematic reviews were of high quality, 3 were of low quality, and 5 were of very low quality. The main reasons for the low methodological quality were the failure to report the preliminary study protocol, the list and reasons for excluded studies, the publication bias of the original study and the funding sources. The GRADE evidence quality assessment resulted in 10 systematic reviews addressing seven outcome measures, 41 bodies of evidence, with eight grade graded as intermediate, 23 grade graded as low, and 10 grade graded as very low. TR promoted the improvement of activities of daily living, motor function, quality of life, depressive symptoms and speech function of stroke patients to a certain extent, and had the same curative effect as face-to-face rehabilitation therapy or routine treatment, and even some TR rehabilitation effects were better than traditional rehabilitation therapy. Conclusion TR can promote the functional rehabilitation of stroke patients, but considering that the methodological quality and reliability of outcome measures of current systematic reviews/meta-analyses on the effectiveness of TR applied to functional recovery after stroke are mostly low, strict, standardized and comprehensive high-quality randomized controlled trials are still needed to provide evidence support; The results of this study can provide reference for the topic selection, research design and results report of future TR research.

ObjectiveTo evaluate the methodological quality of systematic review / Meta analysis （SR/MA） of intervention randomized controlled trial （RCT） published in the Sichuan Mental Health.MethodsThe literature databases such as Wanfang Data， China National Knowledge Infrastructure （CNKI）， VIP Database for Chinese Technical Periodical （VIP） and Chinese Biomedical Literature Database （CBM） were searched for the SRs/MAs of intervention RCTs published in the Sichuan Mental Health from the initial issue to the issue published on 31 June 2021. Then the methodological quality of eligible SRs/MAs were assessed using A Measurement Tool to Assess systematic Reviews 2 （AMSTAR 2）.ResultsThe literature search yielded 24 full-text articles， and the mean AMSTAR 2 score of the included SRs/MAs was （5.21±3.63） with a range from 1 to 11. The total AMSTAR 2 score for SRs/MAs showed difference in terms of the publication date prior to or later than the publication of AMSTAR-2 tool （t=-5.499）， number of authors ≤ 2 or ≥ 3 （t=-6.736）， with or without funding support （t=3.329） and author unit nature （F=7.827）， with statistical significance （P

Aims: To evaluate the reporting and methodological quality of relevant systematic reviews (SRs) and meta-analyses (MAs) on Dipeptidyl peptidase-4 inhibitors (DPP-4I) for Type 2 diabetes mellitus (T2DM). Methods: Relevant SRs and MAs on T2DM and DPP-4I published between 2017 and November 2021 were retrieved from PubMed, Embase, Cochrane Library, Web of Science, VIP, CNKI, CBM, and WanFang databases. Two independent reviewers performed the search, selection, and data extraction. The reporting and methodological quality of the reviewers was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tools. The relationship between reporting and methodological quality score was assessed with the Spearman correlation test. Results: Twenty-one studies involving 151,715 participants were included in the study. This overview showed that DPP-4I was safer and more efficacious than other anti-hyperglycemic drugs (OADs) in treating T2DM. The methodological quality of one SR was low, while the rest were very low. Thus, refinements are needed in the quality of protocol and registration information, a complete search strategy, the summary of the evidence, the listing of excluded studies, assessing the potential impact of risk of bias in RCTs, and discussing the RoB on MA results, and the funding of RCTs need improvement for generating SR. In addition, the reporting and methodological quality scores were moderately correlated (rS = 0.66, P = 0.001). Conclusions: DPP-4I is safer and more efficacious than OADs in treating T2DM. However, the reporting and methodological quality of the related SRs was unsatisfactory. Therefore, PRISMA and AMSTAR 2 analyses should be followed to enhance the overall quality of future SRs. [ABSTRACT FROM AUTHOR]

Systematic reviews (SR) and systematic reviews with meta-analysis (SRMA) can constitute the highest level of research evidence. Such evidence syntheses are relied upon heavily to inform the clinical knowledge base and to guide clinical practice for meningioma. This review evaluates the reporting and methodological quality of published meningioma evidence syntheses to date. Eight electronic databases/registries were searched to identify eligible meningioma SRs with and without meta-analysis published between January 1990 and December 2020. Articles concerning spinal meningioma were excluded. Reporting and methodological quality were assessed against the following tools: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2), and Risk Of Bias in Systematic reviews (ROBIS). 116 SRs were identified, of which 57 were SRMAs (49.1%). The mean PRISMA score for SRMA was 20.9 out of 27 (SD 3.9, 77.0% PRISMA adherence) and for SR without meta-analysis was 13.8 out of 22 (SD 3.4, 63% PRISMA adherence). Thirty-eight studies (32.8%) achieved greater than 80% adherence to PRISMA. Methodological quality assessment against AMSTAR 2 revealed that 110 (94.8%) studies were of critically low quality. Only 21 studies (18.1%) were judged to have a low risk of bias against ROBIS. The reporting and methodological quality of meningioma evidence syntheses was poor. Established guidelines and critical appraisal tools may be used as an adjunct to aid methodological conduct and reporting of such reviews, in order to improve the validity and transparency of research which may influence clinical practice. [ABSTRACT FROM AUTHOR]

Research quality in pediatric surgery has been challenged by multiple factors, including the low incidence of some congenital pathologies and rare event rates. With the rapid increase of pediatric surgical literature, there is a need for systematic reviews to synthesize evidence. It is important to assess the quality of these systematic reviews. This study aims to examine the reporting of systematic reviews and meta-analyses, using inguinal hernia repair as an index diagnosis. MEDLINE, Embase, and CINAHL databases were searched for systematic reviews and/or meta-analyses of interventions on inguinal hernia in the pediatric population. The quality reporting was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) 2 tools. Of 1449 unique reports, 21 studies were included (15 meta-analyses and six systematic reviews). Median percent reported items for PRISMA and AMSTAR 2 were 72.2% and 70.5%, respectively. The least reported items in PRISMA were protocol registration (27.6%), synthesis of results (13.0%), and a risk of bias across studies (20.6%). For AMSTAR 2, the least reported items were reporting of source of funding (14.3%), appropriate methods for statistical combination of results (25.0%), and pre-establishment of protocol (28.6%). All critical items were completely or partially fulfilled in 5/21 (23.8%) of the studies and completely absent in 1/21 (4.8%) studies. The results of this study highlight relatively good reporting quality, yet a poor methodological quality of systematic reviews/meta-analyses in the pediatric surgery literature on inguinal hernia management. [ABSTRACT FROM AUTHOR]

To assess the reliability of the methodological quality and outcome measures of systematic reviews (SR)/meta-analysis of premature ovarian insufficiency (POI) treated with acupuncture. SR/meta-analysis of POI treated with acupuncture were searched on POI from the databases including PubMed, Web of Science, EMBase, the Cochran Library, Chinese biomedical literature database (SinoMed), China journal full-text database (CNKI), Wanfang data knowledge service platform (Wanfang) and VIP information Chinese periodical service platform (VIP), from inception to 1st May 2021. Using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) scale and Grades of Recommendations Assessment, Development and Evaluation (GRADE) system, the methodological quality and outcome measures of the included studies were appraised. Ten articles of SR/meta-analysis were included, published from 2015 to 2020. Using AMSTAR 2, 5 articles of SR/meta-analysis were rated as critical low quality in methods, 3 articles as low quality, and 2 articles as moderate quality. The results of GRADE showed that among the 50 outcomes the quality of evidence of 22 outcomes was very low, that of 25 outcomes was low and that of 3 outcomes was moderate. The methodological quality and the reliability of outcome measures were not high in existing SR/meta-analysis on POI treated with acupuncture, which may affect the translation of the SR/meta-analysis findings into clinical practice. It is necessary to further strengthen the methodological quality and reporting standard of SR/meta-analysis, as well as the robustness of design and implementation of randomized controlled trials(RCTs), in order to generate high quality evidences for clinical decision-making and practice. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a common chronic disease that can be treated and monitored with various digital technologies. Digital technologies offer unique opportunities for treating and monitoring people with chronic diseases, but little is known about whether the outcomes of such technologies depend on sex, gender, or age in people with COPD. Objective: The general objective of this study is to assess the possible influence of sex, gender, or age on outcomes of digital technologies for treatment and monitoring of COPD through an overview of systematic reviews. Methods: The study is planned as an overview of systematic reviews. Study reporting is based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) 2020 guidelines because guidelines for overviews are not available as of this writing. The information sources for the overview will include 4 bibliographic databases (MEDLINE, Cochrane Library, Epistemonikos, and Web of Science) as well as the bibliographies of the included systematic reviews. The electronic search strategy will be developed and conducted in collaboration with an experienced database specialist. The search results will be presented in accordance with the PRISMA 2020 guidelines. The eligibility of studies is based on the population, intervention, comparison, outcomes, and study design (PICOS) criteria: (1) people with COPD (population), (2) digital technology intervention for treatment or monitoring (intervention), (3) any control group or no control group (comparison), (4) any outcome, and (5) systematic review of randomized controlled trials or non-randomized controlled trials with or without a meta-analysis (study design). Critical appraisal of the included systematic reviews will be performed using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data will be extracted using a standardized data extraction sheet. Results: The literature search is scheduled for June 2022. We expect to select the relevant systematic reviews, code the data, and appraise the systematic reviews by December 2022. Conclusions: There is a growing recognition that the influence of sex, gender, or age should be considered in research design and outcome reporting in the context of health care interventions. Our overview will identify systematic reviews of various digital technologies for treatment or monitoring of COPD. The most interesting aspect of the overview will be to investigate if any systematic reviews considered the influence of sex, gender, or age on the outcomes of such digital technologies in COPD. Evidence from the overview could be used to guide more individualized (sex, gender, or age-based) recommendations for the use of digital technologies among people with COPD. [ABSTRACT FROM AUTHOR]

Jixin Chen,1,2,&ast; Aifeng Liu,1,2,&ast; Qinxin Zhou,1,2 Weijie Yu,1,2 Tianci Guo,1,2 Yizhen Jia,1,2 Kun Yang,1,2 Puyu Niu,1,2 Huichuan Feng1,2 1Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300381, People’s Republic of China; 2National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300381, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Aifeng LiuDepartment of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, No. 88 Changling Road, Xiqing District, Tianjin, 300381, People’s Republic of ChinaTel +86-13803091533Email draifeng@163.comBackground: Acupuncture has been widely used in the clinical management of osteoarthritis of the knee (KOA). Many systematic reviews (SRs) and meta-analyses (MAs) have reported its effectiveness in relieving pain. This overview aimed to summarize SRs and MAs on the effectiveness and safety of acupuncture for KOA and evaluate their methodological and evidence quality of the included SRs and MAs.Methods: We conducted a comprehensive literature search for SRs and MAs in four Chinese and four international databases from their inception until August 2021. Two researchers independently searched the reviews, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tool was used to evaluate the methodological quality of the included SRs and MAs. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of the included SRs and MAs.Results: A total of 14 SRs and MAs were included. The evaluation results of the AMSTAR 2 tool showed that the methodological quality of all the 14 SRs and MAs was critically low. The principal causes are the lack of a pre-registration proposal and a list of excluded studies and justify the exclusions, the report on the sources of funding, and the reasons for the study designs for inclusion. The results of the GRADE evaluation showed 25 of 46 outcomes were very low-level evidence. Seventeen were of low level, four were of moderate level and none were of high level. Most outcomes were downgraded in quality of evidence mainly because of publication bias and imprecision.Conclusion: The existing evidence suggests that acupuncture seems to be an effective and safe therapy for KOA. However, the deficiencies in the methodological quality and quality of evidence of the included SRs/MAs have limited the reliability of the conclusions. Therefore, further rigorous and comprehensive studies are warranted to verify the effectiveness and safety of acupuncture in KOA.Keywords: acupuncture, knee osteoarthritis, overview, AMSTAR 2, GRADE, systematic review

Abstract Introduction Several published systematic reviews have examined the potential associations between e-cigarette use and cigarette smoking, but their methodological and/or reporting quality have not yet been assessed. This systematic quality review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and AMSTAR (A MeaSurement Tool to Assess systematic Reviews) 2 to evaluate the quality of systematic reviews investigating potential associations between e-cigarette use and cigarette smoking. Materials and methods PubMed/MEDLINE, Embase, and PsycINFO were searched from 01 January 2007 to 24 June 2020. Methodological quality was assessed using AMSTAR 2, and reporting quality was assessed using PRISMA guidelines. Results Of 331 potentially relevant systematic reviews, 20 met predefined inclusion criteria. Most reviews (n = 15; 75%) reported on e-cigarette use and cigarette smoking cessation, while three reported on e-cigarette use and cigarette smoking initiation (15%); and two reported on cigarette smoking initiation and cessation (10%). According to AMSTAR 2 guidelines, 18 of the 20 reviews (90%) were “critically low” in overall confidence of the results, while two were ranked “low.” Additionally, reporting quality varied across the reviews, with only 60% reporting at least half of the PRISMA items. Discussion Methodological limitations were identified across reviews examining potential associations between e-cigarette use and cigarette smoking behaviors, indicating that findings from these reviews should be interpreted with caution. Conclusions Future systematic reviews in this field should strive to adhere to AMSTAR 2 and PRISMA guidelines, to provide high quality syntheses of the available data with transparent and complete reporting.

Since the pandemic of the novel 2019 coronavirus disease (COVID-19), in addition to the harm caused by the disease itself, the psychological damage caused to the public by the pandemic is also a serious problem. The aim of our study was to summarize the systematic reviews/meta-analyses (SRs/MAs) of the prevalence of anxiety, depression and insomnia in different populations during the COVID-19 pandemic and to qualitatively evaluate these SRs/MAs. We searched the Cochrane Library, PubMed and Web of Science to obtain SRs/MAs related to anxiety, depression, and insomnia in different populations during the COVID-19 pandemic. The main populations we studied were healthcare workers (HCWs), college students (CSs), COVID-19 patients (CPs), and the general populations (GPs). A subgroup analysis was performed of the prevalence of psychological disorders. A total of 42 SRs/MAs (8,200,330 participants) were included in calculating and assessing the prevalence of anxiety, depression, and insomnia in these populations. The results of subgroup analysis showed that the prevalence of anxiety in different populations were: HCWs (20–44%), CSs (24–41%), CPs (15–47%), and GPs (22–38%). The prevalence of depression were: HCWs (22–38%), CSs (22–52%), CPs (38–45%), and GPs (16–35%), statistically significant differences between subgroups (p < 0.05). The prevalence of insomnia were: HCWs (28–45%), CSs (27–33%), CPs (34–48%), and GPs (28–35%), statistically significant differences between subgroups (p < 0.05). The comparison revealed a higher prevalence of psychological disorders in the CP group, with insomnia being the most pronounced. The methodological quality of the included SRs/MAs was then evaluated using AMSTAR 2 tool. The results of the methodological quality evaluation showed that 13 SRs/MAs were rated “medium,” 13 were rated “low,” and 16 were rated “very low.” Through the subgroup analysis and evaluation of methodological quality, we found a higher prevalence of insomnia than anxiety and depression among the psychological disorders occurring in different populations during the pandemic, but the sample size on insomnia is small and more high-quality studies are needed to complement our findings.

Background: Systematic reviews (SRs) provide the highest level of evidence and inform evidence-based decision making in health care. Earlier studies found association with industry to be negatively associated with methodological quality of SRs. However, this has not been investigated in SRs on vaccines. Methods: We performed a systematic literature search using MEDLINE and EMBASE in March 2020. The results were restricted to those published between 2016 and 2019 with no language restrictions. Study characteristics were extracted by one person and checked by an experienced reviewer. The methodological quality of the SRs was assessed with the AMSTAR 2 tool by multiple reviewers after a calibration exercise was performed. A summary score for each SR was calculated. The Mann-Whitney U test and Fisher's exact test were performed to compare both groups. Results: Out of 185 SRs that met all inclusion criteria, 27 SRs were industry funded. Those were matched with 30 non-industry funded SRs resulting in a total sample size of 57. The mean AMSTAR 2 summary score across all SRs was 0.49. Overall, the median AMSTAR 2 summary score was higher for the non-industry funded SRs than for the industry-funded SRs (0.62 vs. 0.36; p <.00001). Lower ratings for industry funded SRs were consistent across all but one AMSTAR 2 item, though significantly lower only for three specific items. Conclusion: The methodological quality of SRs in vaccination is comparable to SRs in other fields, while it is still suboptimal. We are not able to provide a satisfactory explanation why industry funded SRs had a lower methodological quality than non-industry funded SRs over recent years. Industry funding is an important indicator of methodological quality for vaccine SRs and should be carefully considered when appraising SR quality. [ABSTRACT FROM AUTHOR]

Background: Several quantitative systematic reviews of Kanglaite (KLT), an herb preparation used to treat cancer and malignant pleural effusion, have been published in recent years. However, the clinical evidence reported in these studies has not been pursued further and the methodological quality of these meta-analyses remains unknown. Therefore, an overview was designed to map the evidence landscape based on the published meta-analyses on KLT in cancer treatment. Methods: Two bibliographic databases (PubMed and Embase) were searched from inception to 25 November 2021. Two independent reviewers were involved in study selection, data abstraction, and methodological quality assessment using AMSTAR 2. The principal features of publications and the clinical outcomes of efficacy and safety were synthesized narratively, and results of methodological quality were reported as frequencies and percentages with the corresponding 95% confidence intervals. The evidence map was used to visualize the overall quality. Excel 2016 and Stata 17/SE were used for data analysis. Results: Thirteen meta-analyses published in English were included for in-depth analysis. Among them, the year of publication ranged from 2008 to 2021, and the number of included patients ranged from 488 to 2,964. Regarding the cancer type, seven articles focused on non-small cell lung cancer, two on malignant pleural effusion, and four reviews on digestive system malignancies, such as hepatocellular carcinoma and pancreatic cancer. Almost all included meta-analyses reported that KLT as adjunctive therapy could improve various efficacy outcomes (such as disease response rates, quality of life, immune indicators) and reduce the rate of occurrence of adverse reactions, such as nausea and vomiting, leukopenia, and anemia. In terms of their methodological quality, three meta-analyses were of low quality, whereas 10 studies were critically low in quality. The methodological flaws main involved items 2 ("predesigned protocol and registration informatio"), 3 ("rationale of study design for inclusion"), 4 ("comprehensive search strategy"), 5 ("literature selection in duplicate"), 7 ("list of excluded studies with reasons"), 8 ("adequate information on included studies"), 10 ("funding support for included primary studies"), and 12 ("evaluation of the potential impact of risk of bias") based on the AMSTAR 2 tool. Conclusion: Current evidence reveals that KLT is effective and safe as an adjunctive treatment for non-small cell lung cancer, malignant pleural effusion, and digestive system malignancies (such as hepatocellular carcinoma). However, the results assessed in this overview should be further verified using well-designed and clearly reported clinical trials and meta-analyses of KLT. [ABSTRACT FROM AUTHOR]

Background: In the past, systematic reviews (SRs) and meta-analyses (MAs) have been used to assess the efficacy of Chinese herbal medicine (CHM) in the treatment of migraines. However, robust conclusions have not yet been determined because of variations in the methodological and evidence quality of these SRs/MAs. Objectives: We aimed to assess the methodological and reporting quality of SRs/MAs and evaluate the available evidence of the efficacy of CHM treatment of migraines. Methods: We searched eight electronic databases from inception until 10 January 2022, without language restrictions. Two researchers were independently responsible for study screening and data extraction. The methodological and reporting quality of SRs/MAs were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The evidence quality of included SRs/MAs was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE). In addition, a descriptive analysis of the included SRs/MAs was included. Results: Sixteen SRs/MAs, including 69 outcomes, were finally included in this overview. Data synthesis of the included SRs/MAs outcomes showed that CHM plus Western medicine (WM) was beneficial in the improvement of migraines. In comparison, there was conflicting evidence for the effectiveness of CHM used alone. CHM was better than WM in improving responder rate and acute medication usage and was superior to placebo in improving migraine days, responder rate, and migraine duration. However, there was insufficient evidence to verify the effectiveness of CHM for migraine treatment regarding pain severity and migraine frequency. All the included SRs/MAs showed extremely low methodological and reporting quality. The results of the GRADE system indicated that the quality of most of the pooled evidence was very low. Conclusions: CHM may be beneficial in improving migraines and can be used as a complementary therapy. However, we should treat the conclusions of the evaluated SRs/MAs cautiously because of the low quality of evidence. Future SRs/MAs should focus on improving methodological and reporting quality. High-quality randomized controlled trials (RCTs) are needed to provide strong evidence for the efficacy of CHM treatment of migraines. [ABSTRACT FROM AUTHOR]

Background: The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods: Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be "high," "moderate," "low," or "critically low." Results: Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of "critically low quality" and two were of "low quality." These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions: The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2's rating rules. [ABSTRACT FROM AUTHOR]

Background: The interaction between heredity and different environmental factors in the modification of apical periodontitis (AP) susceptibility and prediction of its progression remain poorly elucidated. Objectives: This umbrella review aimed to (i) analyse the available relevant systematic reviews in an attempt to determine the association between genotype and allelic distribution of different single‐nucleotide polymorphisms (SNPs) and the development of AP, (ii) report deficiencies and gaps in knowledge in this area and (iii) present recommendations to conduct future clinical studies and systematic reviews. Methods: A literature search was conducted using Clarivate Analytics' Web of Science, Scopus, PubMed and Cochrane Database of Systematic Reviews, from inception to October 2021, with no language restrictions, including a grey literature search. Systematic reviews with/without meta‐analysis evaluating genotype and allelic distribution of different SNPs between adult patients with/ without AP were included. All other type of studies were excluded. The methodological quality was assessed using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR)‐2 tool. Two independent reviewers were involved in study selection, data extraction and appraising the included reviews; disagreements were resolved by a third reviewer. Results: The current study includes five systematic reviews. Three reviews performed meta‐analysis. Three reviews were graded by AMSTAR 2 as 'critically low' quality, whereas the other two were graded as 'low' and 'moderate' quality. Two reviews indicated that carriers of specific genotypes and alleles of tumour necrosis factor‐alpha (TNF‐α) ‐308 G > A and interleukin 1‐beta (IL‐1β) + 3954 C/T gene polymorphisms are more susceptible to an acute and persistent form of AP. However, high heterogeneity was observed. Discussion: The statistical heterogeneity within included systematic reviews was a consequence of clinical and methodological diversity amongst primary studies. Although some of the included reviews suggested that carriers of specific genotype and/or allele of TNF‐α −308 G > A and IL‐1β + 3954 C/T SNPs are more susceptible to AP, their conclusions should be interpreted with caution. Conclusions: No candidate genes could be identified as a definitive genetic risk or protective factor for the development and progression of AP, and further high‐quality genome‐wide association studies are warranted. [ABSTRACT FROM AUTHOR]

Abstract Background Traditional Chinese Medicine (TCM) has been a proposed treatment option for ulcerative colitis (UC), however it has been difficult to understand the breadth and depth of evidence as various Chinese medicine therapies may produce effects differently. The aim of this evidence mapping is to visually understand the available evidence in the use of TCM in the treatment of UC, and to identify gaps in evidence to inform priorities of future research. Methods A systematic electronic literature search of six databases were performed to identify systematic reviews (SRs) on different Chinese medicine therapies in the treatment in UC. Methodological quality of the included SRs was assessed using AMSTAR 2. Results The mapping was based on 73 SRs, which included nine interventions that met eligibility criteria. The quality of the included SRs was very low. The diseases stages of patients with UC varied greatly, from active to remission, to non-acute outbreak, to not reported. The results mostly favored the method of intervention. Oral administration combined with enema was the most widely used route of administration in secondary research. Conclusion Based on the current evidence, the treatment of UC with TCM can only be recommended cautiously. A majority of included SRs did not report the location of the disease, the disease classification, and the route of administration of the intervention. Further research is needed on the effectiveness of Chinese medicine alone in the treatment of UC. The effectiveness of combined Chinese and conventional medicine combined with different routes of administration cannot be confirmed. Attention should be paid to the methodological quality of the systematic review. Unifies the outcome indicators used in the evaluation of effectiveness.

• AI, and ML/DL models are ubiquitously utilized to manage gliomas therefore we critically appraised level 1a evidence using AMSTAR II. • Low compliance was observed in critical domains like study exclusion, meta-analytical methods, and publication bias assessment. • Evidence quality is moderate-to-low for multiple neuro-oncological applications. • Evidence quality is low for glioma diagnosis and molecular markers like MGMT promoter methylation status, IDH, and 1p19q identification. • Evidence quality is critically low for tumor segmentation, glioma grading, and the identification of multiple molecular markers. Gliomas are the most common primary malignant intraparenchymal brain tumors with a dismal prognosis. With growing advances in artificial intelligence, machine learning and deep learning models are being utilized for preoperative, intraoperative and postoperative neurological decision-making. We aimed to compile published literature in one format and evaluate the quality of level 1a evidence currently available. Using PRISMA guidelines, a comprehensive literature search was conducted within databases including Medline, Scopus, and Cochrane Library, and records with the application of artificial intelligence in glioma management were included. The AMSTAR 2 tool was used to assess the quality of systematic reviews and meta -analyses by two independent researchers. From 812 studies, 23 studies were included. AMSTAR II appraised most reviews as either low or critically low in quality. Most reviews failed to deliver in critical domains related to the exclusion of studies, appropriateness of meta -analytical methods, and assessment of publication bias. Similarly, compliance was lowest in non-critical areas related to study design selection and the disclosure of funding sources in individual records. Evidence is moderate to low in quality in reviews on multiple neuro-oncological applications, low quality in glioma diagnosis and individual molecular markers like MGMT promoter methylation status, IDH, and 1p19q identification, and critically low in tumor segmentation, glioma grading, and multiple molecular markers identification. AMSTAR 2 is a robust tool to identify high-quality systematic reviews. There is a paucity of high-quality systematic reviews on the utility of artificial intelligence in glioma management, with some demonstrating critically low quality. Therefore, caution must be exercised when drawing inferences from these results. [ABSTRACT FROM AUTHOR]

Aim: The aims of the study were to assess the methodological quality of systematic reviews with network meta‐analyses (NMAs) in Endodontics using the 'A MeaSurement Tool to Assess systematic Reviews' (AMSTAR 2) tool, and to evaluate the overall confidence in the results of the individual reviews included in the analysis. Methodology: Systematic reviews with NMAs within the specialty of Endodontics published in English were identified from the PubMed, EbBSCOhost and SCOPUS databases from inception to July 2021. Two reviewers were involved independently in the selection of the reviews, data extraction, methodological quality assessment and overall confidence rating. Disagreements were resolved by discussion between the reviewers to achieve consensus; if disagreements persisted, a third reviewer made the final decision. The methodological quality of the included NMAs was appraised using the AMSTAR 2 checklist, which contains 16 items. The reviewers scored each item—'Yes'—when the item was fully addressed, 'Partial Yes'—when the item was not fully addressed, or 'No'—when the item was not addressed. The overall confidence in the results of each review was classified as 'High', 'Moderate', 'Low' or 'Critically low' based on the criteria reported by the AMSTAR 2 developers. Results: Twelve systematic reviews with NMAs were included. All the NMAs adequately reported Item 1 ('Did the research questions and inclusion criteria for the review include the components of PICO?'), Item 8 ('Did the review authors describe the included studies in adequate detail?'), Item 9 ('Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?') and Item 16 ('Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?'), whereas only one NMA reported Item 10 adequately ('Did the review authors report on the sources of funding for the studies included in the review?'). The overall confidence in the results of eight reviews was categorized as 'Critically low', one review was 'Low', two reviews were 'Moderate' and one review was 'High'. Conclusion: The overall confidence in the results for the majority of systematic reviews with NMAs in Endodontics was judged to be 'Critically low' as their methodological quality was below the necessary standard. AMSTAR 2 and PRISMA for NMA guidelines are available to guide authors to produce high‐quality systematic reviews with NMAs and for editors and peer‐reviewers when assessing submissions to journals. [ABSTRACT FROM AUTHOR]

• Using critical appraisal to ensure systematic review rigor. • Using quality assessment tools to methodically appraise systematic review. • Considerations for peer reviewing manuscripts. Methodological transparency and reproducibility are essential for systematic reviews. Peer review of systematic review manuscripts ensures researchers achieve transparency and reproducibility. Using critical appraisal and quality assessment tools is a methodological way for peer reviewers to conduct a thorough critique to assess the rigor and transparency of the systematic review. [ABSTRACT FROM AUTHOR]

Liu Chun,1 Xuanlin Li,2 Zhenzhen Feng,2 Yang Xie,3 Jiansheng Li2,3 1Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, People’s Republic of China; 2Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan & Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, Henan, 450046, People’s Republic of China; 3Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, 450000, People’s Republic of ChinaCorrespondence: Jiansheng LiHenan University of Chinese Medicine, No. 156 Jinshui East Road, Zhengzhou, 450046, People’s Republic of ChinaTel +86-371-65676568Email li_js8@163.comBackground: Since consistent evidence on the effectiveness of acupuncture in the treatment of chronic obstructive pulmonary disease (COPD) is not available, this overview aims to summarize and critically evaluate the methodological and evidence quality of systematic reviews (SRs) on this topic.Methods: Eight electronic databases were searched to identify relevant SRs of the use of acupuncture in the treatment of COPD from inception to January 2021. Two researchers independently screened the literature, extracted the data, and cross-checked the data. The Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) list was used to assess the methodological quality of SRs. The Grades of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the quality of evidence for the outcomes of interest.Results: Nine SRs that conducted quantitative syntheses were included in this overview. The methodological quality of the SRs and the quality of evidence for the main outcome measures were generally unsatisfactory. Only 2 SRs were rated as low methodological quality by AMSTAR 2, and the remaining SRs were rated as critically low quality. The key limitations of the SRs were lack of a protocol and registration or a list of excluded studies. We did not find high-quality evidence to confirm the effectiveness of acupuncture for COPD, and the main reason was that the qualitative data synthesis relied on trials with small sample sizes and critically low quality.Conclusion: Acupuncture appears to be an effective therapeutic method for COPD, but the credibility of the results is limited owing to the generally low methodological quality and evidence quality of the included SRs. Further rigorous and comprehensive studies are required to provide robust evidence and draw definitive conclusions.Keywords: acupuncture, chronic obstructive pulmonary disease, overview, AMSTAR 2, GRADE, systematic review

Background: Coronavirus disease 2019 (COVID-19) has already spread around the world. The modality of traditional Chinese medicine (TCM) combined with Western medicine (WM) approaches is being used to treat COVID-19 patients in China. Several systematic reviews (SRs) are available highlighting the efficacy and safety of TCM combined with WM approaches in COVID-19 patients. However, their evidence quality is not completely validated. Purpose: We aimed to assess the methodological quality and the risk of bias of the included SRs, assess the evidence quality of outcomes, and present their trends and gaps using the evidence mapping method. Methods: PubMed, Cochrane Library, Embase, CNKI, CBM, and Wanfang Data were searched from inception until March 2021 to identify SRs pertaining to the field of TCM combined with WM approaches for COVID-19. The methodological quality of the SRs was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), the risk of bias of the included SRs was assessed with the Risk of Bias in Systematic Review (ROBIS) tool, and the evidence quality of outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: In total, 23 SRs were found eligible. Twenty-one were rated of moderate confidence by AMSTAR 2, while 12 were rated at low risk using the ROBIS tool. In addition, most outcomes were graded as having moderate quality using the GRADE system. We found that the combined use of TCM and WM approaches could improve the CT recovery rate, effective rate, viral nucleic acid negative conversion rate, and the disappearance rate of fever, cough, and shortness of breath. Also, these approaches could decrease the conversion rate from mild to critical, white blood cell counts, and lymphocyte counts and shorten the time to viral assay conversion and the length of hospital stay. Conclusion: TCM combined with WM approaches had advantages in efficacy, laboratory, and clinical symptom outcomes of COVID-19, but the methodological deficiencies of SRs should be taken into consideration. Therefore, to better guide clinical practice in the future, the methodological quality of SRs should still be improved, and high-quality randomized controlled trials (RCTs) and observational studies should also be carried out. [ABSTRACT FROM AUTHOR]

Abstract Background Many systematic reviews of clinical trials on acupuncture were performed within the Cochrane Collaboration, the evidence-based medicine (EBM) most recognized organization. Objective of the article was to systematically collect and identify systematic reviews of acupuncture published in the Cochrane Library and assess their quality from a methodological perspective. Methods A comprehensive literature search was performed in the Cochrane Database of Systematic Reviews to identify the reviews of acupuncture conducted until June 2019. The methodological quality of the included reviews was assessed using the AMSTAR 2 checklist, an evaluation tool for systematic reviews. Results Out of a total of 126 eligible reviews, 50 systematic reviews were included. According to the AMSTAR 2, 52% of Cochrane Systematic Reviews (CSRs) were of low quality, due to the presence of one or more weaknesses in at least one of the domains defined as critical for the methodological quality assessment. The less satisfied critical domain was inadequate investigation and discussion of publication bias. Declaration of potential sources of conflict of interest, and funding of the authors of the review and of the included studies were other important weaknesses. Conclusions The main methodological flaws in the included CSRs were related to topics of relatively new concern in the conduction of systematic reviews of the literature. However, both, lack of attention about retrieval of negative studies, and statements about conflict of interests are crucial point for the evaluation of therapeutic interventions according to EBM methodology.

Abstract Background Antidepressants are prescribed widely to manage low back pain. There are a number of systematic reviews and meta-analyses which have investigated the efficacy of the treatments, while the methodological quality of them has not been assessed yet. This study aims to evaluate the methodological quality of the systematic reviews and meta-analyses investigating the effect of antidepressants on low back pain. Methods A systematic search was conducted in PubMed, EMBASE, Medline, and Cochrane Library databases up to November 2018. The 16-item Assessment of Multiple Systematic Reviews (AMSTAR2) scale was used to assess the methodological quality of the studies. Systematic reviews and meta-analyses of the Antidepressants treatment effects on low back pain published in English language were included. There was no limitation on the type of Antidepressants drugs, clinical setting, and study population, while non-systematical reviews and qualitative and narrative reviews were excluded. Results A total of 25 systematic reviews and meta-analyses were evaluated; the studies were reported between 1992 and 2017. Obtained results from AMSTAR2 showed that 11 (44%), 9 (36%) and 5 (20%) of the included studies had high, moderate and low qualities, respectively. 13(52%) of studies assessed risk of bias and 2(20%) of meta analyses considered publication bias. Also, 16 (64%) of the included reviews provided a satisfactory explanation for any heterogeneity observed in the results. Conclusions Although the trend of publishing high quality papers in ADs effect on LBP increased recently, performing more high-quality SRs and MAs in this field with precise subgroups of the type of pains, the class of drugs and their dosages may give clear and more reliable evidence to help clinicians and policymakers.

Background: Coronavirus disease 2019 (COVID-19) has already spread around the world. The modality of traditional Chinese medicine (TCM) combined with Western medicine (WM) approaches is being used to treat COVID-19 patients in China. Several systematic reviews (SRs) are available highlighting the efficacy and safety of TCM combined with WM approaches in COVID-19 patients. However, their evidence quality is not completely validated.Purpose: We aimed to assess the methodological quality and the risk of bias of the included SRs, assess the evidence quality of outcomes, and present their trends and gaps using the evidence mapping method.Methods: PubMed, Cochrane Library, Embase, CNKI, CBM, and Wanfang Data were searched from inception until March 2021 to identify SRs pertaining to the field of TCM combined with WM approaches for COVID-19. The methodological quality of the SRs was assessed using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2), the risk of bias of the included SRs was assessed with the Risk of Bias in Systematic Review (ROBIS) tool, and the evidence quality of outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.Results: In total, 23 SRs were found eligible. Twenty-one were rated of moderate confidence by AMSTAR 2, while 12 were rated at low risk using the ROBIS tool. In addition, most outcomes were graded as having moderate quality using the GRADE system. We found that the combined use of TCM and WM approaches could improve the CT recovery rate, effective rate, viral nucleic acid negative conversion rate, and the disappearance rate of fever, cough, and shortness of breath. Also, these approaches could decrease the conversion rate from mild to critical, white blood cell counts, and lymphocyte counts and shorten the time to viral assay conversion and the length of hospital stay.Conclusion: TCM combined with WM approaches had advantages in efficacy, laboratory, and clinical symptom outcomes of COVID-19, but the methodological deficiencies of SRs should be taken into consideration. Therefore, to better guide clinical practice in the future, the methodological quality of SRs should still be improved, and high-quality randomized controlled trials (RCTs) and observational studies should also be carried out.

Background: Many systematic reviews (SRs) have reported the efficacy of acupuncture in improving Parkinson's disease (PD), but the quality of evidence is unknown. Therefore, it is necessary to comprehensively summarize and objectively evaluate the evidence of acupuncture for PD., Methods: Seven databases were searched to retrieve SRs on the acupuncture for PD. Two reviewers independently completed literature retrieval, screening, and data extraction. The methodological quality, risk of bias (RoB), evidence quality of the included SRs were assessed by the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2), the Risk of Bias in Systematic Reviews (ROBIS), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool., Results: A total of 24 SRs were included. According to AMSTAR 2, 6 (25%) were rated as high quality, 6 (25%) were rated as moderate quality, and 12 (50%) were rated as very low quality. The application of the ROBIS tool showed that 12 (25%) SRs were at low risk of bias. The results of GRADE showed that 8 (7.62%) outcomes provided high quality evidence, 23 (21.9%) outcomes provided moderate quality evidence, 42 (40%) outcomes provided low quality evidence, and 32 (30.48%) outcomes provided very low quality evidence., Conclusion: The overview indicates that acupuncture shows promise as a treatment for PD, although the evidence is limited and inconclusive due to methodological flaws and the heterogeneity of existing studies. Future research should focus on fully reporting methodological details and following review guidelines to produce more reliable and consistent evidence on the effectiveness of acupuncture for PD., Systematic Review Registration: https://inplasy.com, identifier INPLASY202480049., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xue, He, Wu, Fan and Li.)