Recent KSR Critical Appraisals

  • 1

    Honey for acute cough in children

    Oduwole, Olabisi ; Udoh, Ekong E. ; Oyo-Ita, Angela ; Meremikwu, Martin M.

    Risk of Bias Assessment: Low

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

    Bottom line Evidence suggests that giving honey for up to three days probably relieves cough symptoms and cough duration to a greater extent than placebo or salbutamol, while salbutamol is more effective in relieving the impact of a cough on the quality of sleep of children and their parents. Moreover, honey is more effective in reducing cough frequency, cough severity, the bothersome cough, impact of a cough on sleep for both children and parents compared with no treatment or placebo when given for one day. The findings of this review appear reliable.

    Cochrane Database Syst Rev 2018, 4, CD007094, 10.1002/14651858.CD007094.pub5

  • 2

    Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors

    Arbyn, M. ; Xu, L. ; Simoens, C. ; Martin‐Hirsch, P. P. L.

    Risk of Bias Assessment: Low

    All domains were considered at low concern. A range of comments were made about the review which can be found or are cited in the comments section of the review in the Cochrane Library.

    Bottom line HPV vaccines protect against cervical precancer in adolescent girls and women vaccinated between 15 and 26 years of age. The protection is lower when a part of the population is already infected with HPV. Longer-term follow-up is needed to assess the impact on cervical cancer. There are limited data from trials on the effect of vaccines on deaths, stillbirth and babies born with malformations. However, no increased risk of serious adverse effects, miscarriage or pregnancy termination was found. These findings are likely to be reliable.

    Cochrane Database Syst Rev 2018, 5, CD009069, 10.1002/14651858.CD009069.pub3

  • 3

    Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies

    Jamnik, J. ; Rehman, S. ; Blanco Mejia, S. ; De Souza, R. J. ; Khan, T. A. ; Leiter, L. A. ; Wolever, T. M. S. ; Kendall, C. W. C. ; Jenkins, D. J. A. ; Sievenpiper, J. L.

    Risk of Bias Assessment: Low

    All domains were considered at low concern. The authors have already acknowledged that publication bias could not be assessed as the number of studies included was small.

    Bottom line The available evidence supports the association between fructose intake and increased risk of incidence of gout. However, there is a lack of evidence to determine the association between intake and increased risk of hyperuricemia. All domains were considered at low concern. The authors have already acknowledged that publication bias could not be assessed as the number of studies included was small. Further research with more prospective studies is needed to understand better the role of fructose and its food sources in the development of gout and hyperuricemia.

    BMJ OPEN 2016;6(10);

  • 4

    Comparison of effects of seven treatment methods for distal radius fracture on minimizing complex regional pain syndrome

    Wang, J. H. ; Sun, T.

    Risk of Bias Assessment: High

    A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Bottom line The current evidence indicates that bridging external fixation, K-wire fixation, dorsal plating, volar plating, dorsal and volar plating, plaster fixation and non-bridging external fixation can have no marked difference in risk of complex regional pain syndrome in distal radius fracture patients. A restriction to the Chinese and English language means that some relevant studies may have been missed. The search terms were reported, but full details of the search strategy were not reported. No information was provided regarding the number of authors involved in the study selection process.

    Arch Med Sci 2017;13(1);163-73

  • 5

    Can screening instruments accurately determine poor outcome risk in adults with recent onset low back pain? A systematic review and meta-analysis

    Karran, E. L. ; McAuley, J. H. ; Traeger, A. C. ; Hillier, S. L. ; Grabherr, L. ; Russek, L. N. ; Moseley, G. L.

    Risk of Bias Assessment: High

    The search terms were reported, but full details of the search strategy were not reported, so it was not possible to judge if it was appropriate. Only English language publications were eligible. Robustness of the findings was not addressed.

    Bottom line The evidence indicates that lower back pain screening instruments used in primary care perform poorly by assigning higher risk scores to individuals with chronic pain than to those who do not. Whereas risks of a poor disability outcome and prolonged absenteeism are likely to be estimated with greater accuracy. A restriction to English language studies and absence of a full search strategy means that some relevant studies might have been missed. In addition, the robustness of the findings was not demonstrated. Further studies on these screening instruments for determining risk of poor outcome in adults with lower back pain are needed to support the current findings.

    BMC Med 2017;15(1);

  • 6

    Percutaneous endoscopic lumbar discectomy for recurrent lumbar disc herniation

    Li, X. ; Hu, Z. ; Cui, J. ; Han, Y. ; Pan, J. ; Yang, M. ; Tan, J. ; Sun, G. ; Li, L.

    Risk of Bias Assessment: Unclear

    Search terms were provided but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved.

    Bottom line The evidence indicated that operative time, blood loss and complication rates were significantly reduced with percutaneous endoscopic lumbar discectomy in patients with recurrent lumbar disc herniation in comparison with open lumbar microdiscectomy. Whereas, the difference between the treatment groups were similar in terms of pain reduction, global perceived effect (MacNab score), re-operation and recurrence rate. Hence, percutaneous endoscopic lumbar discectomy could be used as an alternative to the conventional procedure in the treatment of recurrent lumbar disc herniation. Search terms were provided, but a full search strategy was not reported, therefore it was not possible to judge if all relevant studies had been retrieved. Further high-quality randomised controlled trials were required to address the present review question.

    Int J Surg 2016;27();8-16