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Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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The effectiveness of case management for cancer patients: an umbrella review.

Autores Wang N , Chen J , Chen W , Shi Z , Yang H , Liu P , Wei X , Dong X , Wang C , Mao L , Li X
Revista BMC health services research
Año 2022
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 8 Revisiones sistemáticas Revisiones sistemáticas (8 referencias)

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BACKGROUND: Case management (CM) is widely utilized to improve health outcomes of cancer patients, enhance their experience of health care, and reduce the cost of care. While numbers of systematic reviews are available on the effectiveness of CM for cancer patients, they often arrive at discordant conclusions that may confuse or mislead the future case management development for cancer patients and relevant policy making. We aimed to summarize the existing systematic reviews on the effectiveness of CM in health-related outcomes and health care utilization outcomes for cancer patient care, and highlight the consistent and contradictory findings. METHODS: An umbrella review was conducted followed the Joanna Briggs Institute (JBI) Umbrella Review methodology. We searched MEDLINE (Ovid), EMBASE (Ovid), PsycINFO, CINAHL, and Scopus for reviews published up to July 8th, 2022. Quality of each review was appraised with the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis was performed, the corrected covered area was calculated as a measure of overlap for the primary studies in each review. The results were reported followed the Preferred reporting items for overviews of systematic reviews checklist. RESULTS: Eight systematic reviews were included. Average quality of the reviews was high. Overall, primary studies had a slight overlap across the eight reviews (corrected covered area = 4.5%). No universal tools were used to measure the effect of CM on each outcome. Summarized results revealed that CM were more likely to improve symptom management, cognitive function, hospital (re)admission, treatment received compliance, and provision of timely treatment for cancer patients. Overall equivocal effect was reported on cancer patients' quality of life, self-efficacy, survivor status, and satisfaction. Rare significant effect was reported on cost and length of stay. CONCLUSIONS: CM showed mixed effects in cancer patient care. Future research should use standard guidelines to clearly describe details of CM intervention and its implementation. More primary studies are needed using high-quality well-powered designs to provide solid evidence on the effectiveness of CM. Case managers should consider applying validated and reliable tools to evaluate effect of CM in multifaced outcomes of cancer patient care.

Síntesis amplia

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Development and validation of paired MEDLINE and Embase search filters for cost-utility studies.

Revista BMC medical research methodology
Año 2022
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 437 Estudios primarios Estudios primarios (437 referencias) 63 Revisiones sistemáticas Revisiones sistemáticas (63 referencias)

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BACKGROUND: Search filters are standardised sets of search terms, with validated performance, that are designed to retrieve studies with specific characteristics. A cost-utility analysis (CUA) is the preferred type of economic evaluation to underpin decision-making at the National Institute for Health and Care Excellence (NICE). Until now, when searching for economic evidence for NICE guidelines, we have used a broad set of health economic-related search terms, even when the reviewer's interest is confined to CUAs alone. METHODS: We developed search filters to retrieve CUAs from MEDLINE and Embase. Our aim was to achieve recall of 90% or better across both databases while reducing the overall yield compared with our existing broad economic filter. We used the relative recall method along with topic expert input to derive and validate 3 pairs of filters, assessed by their ability to identify a gold-standard set of CUAs that had been used in published NICE guidelines. We developed and validated MEDLINE and Embase filters in pairs (testing whether, when used together, they find target studies in at least 1 database), as this is how they are used in practice. We examined the proxy-precision of our new filters by comparing their overall yield with our previous approach using publications indexed in a randomly selected year (2010). RESULTS: All 3 filter-pairs exceeded our target recall and led to substantial improvements in search proxy-precision. Our paired 'sensitive' filters achieved 100% recall (95% CI 99.0 to 100%) in the validation set. Our paired 'precise' filters also had very good recall (97.6% [95%CI: 95.4 to 98.9%]). We estimate that, compared with our previous search strategy, using the paired 'sensitive' filters would reduce reviewer screening burden by a factor of 5 and the 'precise' versions would do so by a factor of more than 20. CONCLUSIONS: Each of the 3 paired cost-utility filters enable the identification of almost all CUAs from MEDLINE and Embase from the validation set, with substantial savings in screening workload compared to our previous search practice. We would encourage other researchers who regularly use multiple databases to consider validating search filters in combination as this will better reflect how they use databases in their everyday work.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Effectiveness of weight loss interventions in breast cancer survivors: a systematic review of reviews.

Autores Lake B , Damery S , Jolly K
Revista BMJ open
Año 2022
Enlaces Pubmed DOI

Este artículo incluye 16 Revisiones sistemáticas Revisiones sistemáticas (16 referencias) 1 Estudio primario Estudios primarios (1 referencia)

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BACKGROUND: Elevated body mass index (BMI) in breast cancer survivors (BCS) is associated with cancer recurrence and poorer treatment response. Guidelines recommend 5%-10% weight loss for overweight or obese BCS. OBJECTIVES: To assess effectiveness of lifestyle interventions for female BCS on weight loss, BMI, body composition, health-related quality of life (HRQoL), physical functioning, psychosocial measures, biomarkers. DESIGN: Systematic review of reviews and meta-analyses. SETTING: All clinical settings. PARTICIPANTS: Adult female BCS (active treatment or post-treatment). METHODS: Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including Database of Abstracts of Reviews of Effects) were searched for systematic reviews published in English between 1990 and 2022, with weight, BMI or body fat as primary outcome. Narrative reviews, editorials, letters, conference abstracts were excluded. Review quality was assessed using the Joanna Briggs Institute quality assessment tool. RESULTS: 17 reviews were included. Twelve reported significant reductions in one or more anthropometric outcomes: weight -1.36 kg (95% CI:-2.51 to -0.21) to -3.8 kg (95% CI: -5.6 to -1.9); BMI -0.89 kg/m2 (95% CI: -0.15 to -0.28) to -3.59 kg/m2 (95% CI: -6.29 to 0.89) or body fat -1.6% (95% CI: -2.31 to -0.88) to -2.6% (95% CI not reported). Significant reductions in two or more anthropometric outcomes were reported in 7/12 reviews, with effective interventions comprising aerobic exercise/aerobic exercise plus resistance training (n=5), or diet and exercise with or without counselling (n=2). Significant improvements were also reported for HRQoL (8/11 reviews), mental health (4/7) and physical functioning (2/3). Group interventions comprising aerobic exercise or aerobic exercise plus resistance training were most likely to improve outcomes. CONCLUSIONS: Lifestyle interventions can significantly improve outcomes for BCS. Multimodal interventions are likely to have the greatest impact in reducing weight, BMI and body fat. Further research must define the optimal combination, intensity and duration of effective interventions. PROSPERO REGISTRATION NUMBER: CRD42021283481.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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A meta-review demonstrates improved reporting quality of qualitative reviews following the publication of COREQ- and ENTREQ-checklists, regardless of modest uptake.

Revista BMC medical research methodology
Año 2021
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 1608 Revisiones sistemáticas Revisiones sistemáticas (1608 referencias) 31 Estudios primarios Estudios primarios (31 referencias)

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BACKGROUND: Reviews of qualitative studies allow for deeper understanding of concepts and findings beyond the single qualitative studies. Concerns on study reporting quality led to the publication of the COREQ-guidelines for qualitative studies in 2007, followed by the ENTREQ-guidelines for qualitative reviews in 2012. The aim of this meta-review is to: 1) investigate the uptake of the COREQ- and ENTREQ- checklists in qualitative reviews; and 2) compare the quality of reporting of the primary qualitative studies included within these reviews prior- and post COREQ-publication. METHODS: Reviews were searched on 02-Sept-2020 and categorized as (1) COREQ- or (2) ENTREQ-using, (3) using both, or (4) non-COREQ/ENTREQ. Proportions of usage were calculated over time. COREQ-scores of the primary studies included in these reviews were compared prior- and post COREQ-publication using T-test with Bonferroni correction. RESULTS: 1.695 qualitative reviews were included (222 COREQ, 369 ENTREQ, 62 both COREQ/ENTREQ and 1.042 non-COREQ/ENTREQ), spanning 12 years (2007-2019) demonstrating an exponential publication rate. The uptake of the ENTREQ in reviews is higher than the COREQ (respectively 28% and 17%), and increases over time. COREQ-scores could be extracted from 139 reviews (including 2.775 appraisals). Reporting quality improved following the COREQ-publication with 13 of the 32 signalling questions showing improvement; the average total score increased from 15.15 to 17.74 (p-value < 0.001). CONCLUSION: The number of qualitative reviews increased exponentially, but the uptake of the COREQ and ENTREQ was modest overall. Primary qualitative studies show a positive trend in reporting quality, which may have been facilitated by the publication of the COREQ.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Effectiveness of interventions aimed at improving dietary behaviours among people at higher risk of or with chronic non-communicable diseases: an overview of systematic reviews

Revista European journal of clinical nutrition
Año 2019
Enlaces Pubmed DOI

Este artículo incluye 14 Revisiones sistemáticas Revisiones sistemáticas (14 referencias)

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Programmes that promote dietary behaviour change for the prevention of chronic disease must include components that are rooted in best practice and associated with effectiveness. The purpose of this overview of systematic reviews was to examine the characteristics and dietary behaviour change outcomes of nutrition interventions among populations with or at risk of non-communicable chronic diseases. Systematic reviews of randomised controlled trials (RCTs) testing dietary behaviour change interventions published between January 2006 and November 2015 were identified via searches in Cochrane Library, PubMed, EMBASE and PsycINFO. Quality of reviews were appraised using AMSTAR. Dietary behaviour change and intervention details were extracted and systematically summarised. Fifteen articles met the inclusion criteria. Dietary behaviour changes in response to nutrition interventions were significant in over half of interventions. Reducing dietary fat and increasing fruits and vegetables were the most common behaviour changes. The characteristics of nutrition interventions and their relationship to effectiveness for dietary behaviour change among chronic disease or at-risk populations were reported inconsistently. However, associative evidence exists to support more frequent contacts and the use of specific behaviour change techniques. No clear relationships were found between effectiveness and intervention setting, mode of delivery or intervention provider, although some population-specific relationships were identified. Interventions that promote long-term maintenance of dietary behaviour changes are lacking in the literature. This comprehensive umbrella review identifies specific characteristics of interventions that are associated with effectiveness in interventions that promote dietary behaviour change among different at-risk populations. In order to maximise outcomes, public health, health promotion and healthcare organisations should consider these results in order to inform the development and improvement of nutrition programmes. © 2018, Springer Nature Limited.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Massage for Pain: An Evidence Map.

Revista Journal of alternative and complementary medicine (New York, N.Y.)
Año 2019
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 53 Revisiones sistemáticas Revisiones sistemáticas (53 referencias)

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OBJECTIVES: Massage therapy has been proposed for painful conditions, but it can be difficult to understand the breadth and depth of evidence, as various painful conditions may respond differently to massage. The authors conducted an evidence mapping process and generated an "evidence map" to visually depict the distribution of evidence available for massage and various pain indications to identify gaps in evidence and to inform future research priorities. DESIGN: The authors searched PubMed, Embase, and Cochrane for systematic reviews reporting pain outcomes for massage therapy. The authors assessed the quality of each review using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) criteria. The authors used a bubble plot to depict the number of included articles, pain indication, effect of massage for pain, and strength of findings for each included systematic review. RESULTS: The authors identified 49 systematic reviews, of which 32 were considered high quality. Types of pain frequently included in systematic reviews were cancer pain, low back pain, and neck pain. High quality reviews concluded that there was low strength of evidence of potential benefits of massage for labor, shoulder, neck, low back, cancer, arthritis, postoperative, delayed onset muscle soreness, and musculoskeletal pain. Reported attributes of massage interventions include style of massage, provider, co-interventions, duration, and comparators, with 14 high-quality reviews reporting all these attributes in their review. CONCLUSION: Prior reviews have conclusions of low strength of evidence because few primary studies of large samples with rigorous methods had been conducted, leaving evidence gaps about specific massage type for specific pain. Primary studies often do not provide adequate details of massage therapy provided, limiting the extent to which reviews are able to draw conclusions about characteristics such as provider type.

Síntesis amplia / Living FRISBEE

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¿Son efectivos los cannabinoides para el manejo de náuseas y vómitos inducidos por quimioterapia?

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Autores Núñez A , Núñez C , Corsi O , Rada G
Revista Medwave
Año 2017
Enlaces Pubmed DOI

Este artículo incluye 8 Revisiones sistemáticas Revisiones sistemáticas (8 referencias) 10 Estudios primarios Estudios primarios (10 referencias)

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INTRODUCCIÓN: El síndrome de emaciación (wasting) en VIH/SIDA aún permanece como un problema común, constituyéndose como un factor de mortalidad en esta población. Se ha postulado el uso de cannabinoides como tratamiento de la baja de peso secundaria a la infección por VIH, lo que aún es controvertido. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios y preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 10 estudios primarios, de los cuales, seis son ensayos aleatorizados. Concluimos que no está claro si los cannabinoides aumentan el apetito o incrementan el peso en el síndrome de wasting en pacientes con VIH, y probablemente los efectos adversos son frecuentes.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017).

Revista PM & R : the journal of injury, function, and rehabilitation
Año 2017
Enlaces Pubmed DOI PubMed Central www.epistemonikos.org

Este artículo incluye 50 Revisiones sistemáticas Revisiones sistemáticas (50 referencias)

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BACKGROUND: Evidence supports the benefits of exercise for patients with cancer; however, specific guidance for clinical decision making regarding exercise timing, frequency, duration, and intensity is lacking. Efforts are needed to optimize clinical recommendations for exercise in the cancer population. OBJECTIVES: To aggregate information regarding the benefit of exercise through a systematic review of existing systematic reviews in the cancer exercise literature. DATA SOURCES: PubMed, CINAHL Plus, Scopus, Web of Science, and EMBASE. STUDY ELIGIBILITY CRITERIA: Systematic reviews and meta-analyses of the impact of movement-based exercise on the adult cancer population. METHODS: Two author teams reviewed 302 abstracts for inclusion with 93 selected for full-text review. A total of 53 studies were analyzed. A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used as a quality measure of the reviews. Information was extracted using the PICO format (ie, participants, intervention, comparison, outcomes). Descriptive findings are reported. RESULTS: Mean AMSTAR score = 7.66/11 (±2.04) suggests moderate quality of the systematic reviews. Exercise is beneficial before, during, and after cancer treatment, across all cancer types, and for a variety of cancer-related impairments. Moderate-to-vigorous exercise is the best level of exercise intensity to improve physical function and mitigate cancer-related impairments. Therapeutic exercises are beneficial to manage treatment side effects, may enhance tolerance to cancer treatments, and improve functional outcomes. Supervised exercise yielded superior benefits versus unsupervised. Serious adverse events were not common. LIMITATIONS: Movement-based exercise intervention outcomes are reported. No analysis of pooled effects was calculated across reviews due to significant heterogeneity within the systematic reviews. Findings do not consider exercise in advanced cancers or pediatric populations. CONCLUSIONS: Exercise promotes significant improvements in clinical, functional, and in some populations, survival outcomes and can be recommended regardless of the type of cancer. Although generally safe, patients should be screened and appropriate precautions taken. Efforts to strengthen uniformity in clinical trial reporting, develop clinical practice guidelines, and integrate exercise and rehabilitation services into the cancer delivery system are needed.

Síntesis amplia / Revisión panorámica de revisiones sistemáticas

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Planes de atención de supervivencia para personas con cáncer colorrectal: ¿reflejan la evidencia de la investigación?

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Autores D'Souza V , Daudt H , Kazanjian A
Revista Current oncology (Toronto, Ont.)
Año 2016
Enlaces Pubmed DOI PubMed Central

Este artículo incluye 8 Revisiones sistemáticas Revisiones sistemáticas (8 referencias)

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En el presente estudio, hemos sintetizado la literatura publicada sobre los aspectos psicosociales de la supervivencia del cáncer colorrectal (crc) para apoyar una actualización de la base probatoria de los planes de supervivencia creados en nuestra jurisdicción. MÉTODOS: Se utilizaron como criterios de búsqueda los temas psicosociales identificados en los crc scps creados por dos iniciativas diferentes en nuestra provincia: calidad de vida (qol), función sexual, fatiga y comportamientos de estilo de vida. Se realizó una revisión general para obtener la mejor evidencia posible. Sólo se incluyeron las revisiones que investigaron los resultados esperados en sobrevivientes crc y aquellos con puntuaciones de calidad metodológica de moderada a alta. RESULTADOS: De 462 informes recuperados, ocho revisiones cumplieron con los criterios de inclusión para la síntesis. De los ocho, seis investigaron los desafíos de los sobrevivientes de crc y dos investigaron el efecto de la actividad física sobre el bienestar de los sobrevivientes. Nuestros resultados indican que los desafíos emocionales y físicos son comunes en los supervivientes de crc y que la actividad física está asociada con beneficios clínicamente importantes para la fatiga y el funcionamiento físico de los supervivientes de CRC. CONCLUSIONES: Los hallazgos de nuestro estudio actualizan la evidencia e indican que las exploraciones existentes en nuestra provincia en relación con los desafíos físicos y emocionales de los supervivientes de crc reflejan la evidencia en el momento de su emisión. Sin embargo, la literatura sobre los riesgos de cáncer específicos de CRC supervivientes es deficiente. Aunque las revisiones sistemáticas se consideran el "estándar de oro" en la síntesis del conocimiento, nuestros hallazgos sugieren que queda mucho por hacer en el área de la investigación de síntesis para guiar mejor la práctica en la supervivencia del cáncer.

Síntesis amplia

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Health benefits of tai chi: What is the evidence?

Revista Canadian Family Physician
Año 2016
Enlaces Pubmed

Este artículo incluye 99 Revisiones sistemáticas Revisiones sistemáticas (99 referencias) 3 Estudios primarios Estudios primarios (3 referencias)

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OBJECTIVE: To summarize the evidence on the health benefits of tai chi.Sources Of Information: A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit.Main Message: During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.CONCLUSION: There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.