Recent KSR Evidence critical appraisals

  • 1

    Comparison of confirmed COVID-19 with SARS and MERS cases - clinical characteristics, laboratory findings, radiographic signs and outcomes: a systematic review and meta-analysis

    Pormohammad, A. ; Ghorbani, S. ; Khatami, A. ; Farzi, R. ; Baradaran, B. ; Turner, D.L. ; Turner, R.J. ; et al.

    Risk of Bias Assessment: Low

    This review was well conducted but the pooled estimates of prevalence were affected by high levels of statistical heterogeneity, a limitation which was acknowledged by the authors.

    Bottom line This well-conducted review found that fever and cough were the most common symptoms of COVID-19, SARs and MERS and that thrombocytosis was twice as common with COVID-19 compared to SARS and MERS. The mortality rate in COVID-19 confirmed cases was lower than that of MERS or SARS. The authors noted that these results may be biased as they are based on confirmed cases only and the evidence was highly heterogeneous.

    Lancet. Global Health 2020;Preprint();

  • 2

    School closure and management practices during coronavirus outbreaks including COVID-19: a rapid narrative systematic review

    Viner, R.M. ; Russell, S.J. ; Croker, H. ; Packer, J. ; Ward, J. ; Stansfield, C. ; Mytton, O. ; Bonell, C. ; Booy, R.

    Risk of Bias Assessment: High

    A limited number of databases were searched. Chinese studies with no translation were excluded. Three reviewers were involved in the title/abstract screening and one reviewer was involved in full-text screening, this was considered inappropriate. Only one author was involved in the extraction of articles. There were insufficient study details available to allow the reader to interpret the results. The methodological quality of included studies was not assessed.

    Bottom line The evidence suggests that school closures may make very little difference in the prevention of severe acute respiratory syndrome and low benefits in the prevention of endemic human coronavirus or influenza outbreaks. There is a lack of policy-relevant data on implementation of school social distancing during coronavirus outbreaks. However, data from influenza outbreaks showing benefits of school closures cannot necessarily be applied to coronavirus disease-2019 (COVID-19). Policymakers need to be aware of misleading evidence when proposing or implementing national or regional school closures for COVID-19. The review had significant methodological weaknesses, so the findings should be interpreted with caution. Further studies are warranted to look into other less disruptive school social distancing interventions.

    Lancet Child Adolesc Health 2020;4(5);397-404

  • 3

    Perceptions and behavioral responses of the general public during the 2009 influenza A (H1N1) pandemic: a systematic review

    Bults, M. ; Beaujean, D. J. ; Richardus, J. H. ; Voeten, H. A.

    Risk of Bias Assessment: High

    The restriction of the review to English language publications means that relevant studies may have been missed. Weaknesses in the review methods (the majority of the review process was conducted by one reviewer) raise the potential for error and bias.

    Bottom line Evidence from survey studies conducted across the world indicates that public perceptions and behaviours evolved during and after the 2009 influenza A (H1N1) pandemic. In most countries, perceived vulnerability increased, but perceived severity, anxiety, self-efficacy, and vaccination intention decreased. Improved hygienic practices and social distancing were practised most commonly. The review authors concluded that health authorities should continuously monitor public perceptions and provide up-to-date information, to avoid misconceptions. Because public perceptions and behaviours varied between countries during the pandemic, the review authors also recommended that risk communication should be tailored to the specific circumstances of each country. This article provides a good general overview of the topic, but has been rated high risk of bias because of weaknesses in the review methods and the potential for missed information created by the restriction to English language studies.

    Disaster Med Public Health Prep 2015;9(2);207-19

  • 4

    Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China

    Li, B. ; Yang, J. ; Zhao, F. ; Zhi, L. ; Wang, X. ; Liu, L. ; Bi, Z. ; Zhao, Y.

    Risk of Bias Assessment: High

    This review has substantial methodological weaknesses and has been rated high risk of bias on all domains.

    Bottom line There is some limited evidence to indicate that patients with pre-existing conditions (hypertension, cardiovascular and cerebrovascular disease, and diabetes) may be at increased risk of developing severe coronavirus disease 2019 (COVID-19), i.e. requiring intensive care admission. Conversely, severe COVID-19 may be associated with an increased risk of cardiac injury. This review provides an interesting initial exploration of the possible relationships between some co-morbidities and disease severity in COVID-19. However, the results should be interpreted cautiously, as the review has substantial methodological weaknesses.

    Clin Res Cardiol 2020;109(5);531-8

  • 5

    Potential interventions for novel coronavirus in China: a systematic review

    Zhang, L. ; Liu, Y.

    Risk of Bias Assessment: High

    It is likely that potentially relevant studies have been missed. Not enough details are given on the included studies, e.g. regarding study characteristics and the risk of bias. It is unclear whether all relevant results have been presented.

    Bottom line The review aimed to summarise therapeutic options available for the treatment of novel coronavirus (COVID-19 or 2019-CoV). It identified a number of options, including nutritional interventions, immunoenhancers, coronavirus-specific treatments, antiviral treatments and other compounds with potential therapeutic use in the treatment of COVID-19. Nutritional interventions could have a positive effect on the host immune response against viral infections. Other treatment options have more direct effects on COVID-19 and were shown to be beneficial when used against other coronaviruses (severe acute respiratory syndrome, SARS; Middle East respiratory syndrome, MERS). While the review is useful in identifying potential treatment options, there are a number of limitations. It is likely that potentially relevant studies have been missed by the searches. Interpretation of included studies is hampered by the lack of reporting of study characteristics and the risk of bias was not assessed. It is unclear whether all relevant results have been presented. It should be noted that a number of the included studies were conducted in-vitro or in animal models, i.e. not in humans. Nevertheless, published a few weeks after the COVID-19 outbreak, the review gives an overview of available treatment options. This might guide clinicians treating patients with COVID-19 as well as researchers considering potential treatment options that should be studied in further detail.

    J Med Virol 2020;92(5);479-90

  • 6

    Emerging and re-emerging human infectious diseases: a systematic review of the role of wild animals with a focus on public health impact

    Cupertino, M. ; Resende, M. ; Mayer, N. ; Carvalho, L. ; Siqueira-Batista, R.

    Risk of Bias Assessment: High

    Weaknesses in the search process mean that relevant studies may have been missed and the description of the included studies and their findings was limited.

    Bottom line There is some evidence, from a wide range of geographic regions, to suggest that wild animals (mainly bats, birds and primates) may play a role in the dissemination of aetiological agents (mainly viruses). The review authors concluded that the monitoring of these diseases and adequate preparation for possible epidemics and pandemics are fundamental conditions for the mitigation of their future impact. Weaknesses in the search process mean that relevant studies may have been missed and the description of the included studies and their findings was limited.

    Asian Pac J Trop Med 2020;13(3);99-106

  • 7

    Physical interventions to interrupt or reduce the spread of respiratory viruses

    Jefferson, Tom ; Del Mar, Chris B. ; Dooley, Liz ; Ferroni, Eliana ; Al-Ansary, Lubna A. ; Bawazeer, Ghada A. ; van Driel, Mieke L. ; Nair, Sreekumaran ; Jones, Mark A. ; Thorning, Sarah ; Conly, John M.

    Risk of Bias Assessment: Low

    All domains were considered at low concern suggesting no substantial limitations with the review process.

    Bottom line The available evidence indicates that frequent hand washing, with or without adjunct antiseptics, barrier measures such as gloves and masks, with or without filtration apparatus, are likely to be useful for reducing transmission of epidemic respiratory viruses. There was insufficient data to adequately assess the effectiveness of global and high resource-intensive interventions such as screening at entry ports and social distancing.

    Cochrane Database Syst Rev 2011, 7, CD006207, 10.1002/14651858.CD006207.pub4

  • 8

    Couple therapy for depression

    Barbato, Angelo ; D'Avanzo, Barbara ; Parabiaghi, Alberto

    Risk of Bias Assessment: High

    Only a single reviewer was involved in the initial stage of title and abstract screening, meaning error and bias cannot be ruled out.

    Bottom line Current evidence suggests that couple therapy may be as effective as individual psychotherapy in improving depressive symptoms and more effective in improving relationship distress. However, these conclusions should be interpreted with caution, since reviewer error and bias cannot be ruled out. Future well-designed, high-quality trials are needed to support these findings, with a focus on long-term impact.

    Cochrane Database Syst Rev 2018, 6, CD004188,

  • 9

    Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis

    Black, N. ; Stockings, E. ; Campbell, G. ; Tran, L.T. ; Zagic, Z. ; Hall, W.D. ; Farrell, M. ; Degenhardt, L.

    Risk of Bias Assessment: Low

    It was unclear which criteria were used for the methodological quality assessment of the observational studies. However, overall, no major issues were identified.

    Bottom line There is limited evidence to suggest that cannabinoids improve depressive disorders and symptoms, anxiety disorders, attention-deficit hyperactivity disorder (ADHD), Tourette syndrome, post-traumatic stress disorder (PTSD), or psychosis. The certainty of evidence was usually rated to be low or even very low. However, pharmaceutical tetrahydrocannabinol (THC, with or without cannabidiol) seems to show a small improvement in symptoms of anxiety among individuals with other medical conditions. There is insufficient evidence to provide clear guidance on the use of cannabinoids for treating mental disorders, e.g. within a regulatory framework. Bias in primary studies was addressed while interpreting the findings, but the criteria used for the observational studies were unclear. Further high-quality studies directly examining the effect of cannabinoids on treating mental disorders are needed to support the current findings.

    Lancet Psychiatry 2019;Epub ahead of print();

  • 10

    Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis

    Bolland MJ, Grey A, Avenell A

    Risk of Bias Assessment: High

    The search strategies were not very sensitive, relevant studies may have been missed.

    Bottom line Evidence indicates that vitamin D supplementation may not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. In addition, there were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health. Restriction to one index term for vitamin D in the searches means some relevant studies may have been missed. There was some evidence of publication bias.

    Lancet Diabetes Endocrinol 2018;6(11);847-858

1–10 of 24 results, showing 10 | 20 | 50 results per page