Recent KSR Evidence critical appraisals

  • 1

    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;Epub ahead of print();

  • 2

    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

  • 3

    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

  • 4

    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

  • 5

    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, https://dx.doi.org/10.1002/14651858.CD004188.pub3

  • 6

    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();

  • 7

    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

  • 8

    Health-related values and preferences regarding meat consumption: a mixed-methods systematic review

    Valli, C. ; Rabassa, M. ; Johnston, B.C. ; Kuijpers, R. ; Prokop-Dorner, A. ; Zajac, J. ; Storman, D. ; Storman, M., ; Bala, M.M. ; Solà, I. ; Zeraatkar, D. ; Han, M.A. ; et al.

    Risk of Bias Assessment: Low

    No relevant concerns were identified.

    Bottom line This systematic review identified low-certainty evidence indicating that omnivores are attached to meat and have low willingness to reduce meat consumption. People following a diet with low or no meat consumption cite health as a main reason for that diet. The findings of this systematic review are likely to be robust. However, due to only including studies conducted in Europe, Australia, Canada, the United States, and New Zealand, the results are not generalisable to other settings, e.g. lower income countries.

    Ann Intern Med 2019;171(10);742-55

  • 9

    Red and processed meat consumption and risk for all-cause mortality and cardiometabolic outcomes. A systematic review and meta-analysis of cohort studies

    Zeraatkar, D. ; Han, M.A. ; Guyatt, G.H. ; Vernooij, R.W.M. ; El Dib, R. ; Cheung, K. ; Milio, K. ; Zworth, M. ; Bartoszko, J.J. ; Valli, C. ; Rabassa, M. ; Lee, Y. ; et al.

    Risk of Bias Assessment: Unclear

    It was unclear why the review was restricted to studies of more than 1000 participants. Baseline study characteristics regarding cancer risk were not reported. Different meta-analysis methods were used but the results and GRADE assessment were based on the dose-response analysis as this was considered to be the most reliable. However, no justification was provided and 44% of the studies were excluded from this analysis. Some analyses had high statistical heterogeneity and the pooled results may not be reliable.

    Bottom line Evidence from observational studies shows that a reduction of three servings per week of processed or unprocessed red meat may reduce all-cause mortality and cardiometabolic morbidity and mortality. However, the estimated lifetime effects of exposure are very small, the overall certainty of evidence is low or very low, and a causal relationship has not been established. There was a lack of information about other cancer and cardiovascular risk factors and the results of each study. In addition, no justification was provided for the choice of analysis method and 44% of the studies were not analysed.

    Ann Intern Med 2019;Epub ahead of print();

  • 10

    Effect of lower versus higher red meat intake on cardiometabolic and cancer outcomes: a systematic review of randomized trials

    Zeraatkar, D. ; Johnston, B.C. ; Bartoszko, J. ; Cheung, K. ; Bala, M.M. ; Valli, C. ; Rabassa, M. ; Sit, D. ; Milio, K. ; Sadeghirad, B. ; Agarwal, A. ; Zea, A.M. ; Lee, Y. ; et al.

    Risk of Bias Assessment: Low

    No relevant concerns were identified.

    Bottom line This systematic review identified low- or very-low certainty evidence suggesting that diets restricted in red meat may have little or no effect on major cardiometabolic outcomes and cancer mortality and incidence. The systematic review used rigorous methods, i.e. the results are likely to be correct. However, it was largely based on a single study conducted in postmenopausal women (70% overweight or obese, 30%-40% with hypertension) which limits the generalisability of these findings.

    Ann Intern Med 2019;171(10);721-31

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