Systematic review automation technologies Systematic reviews in endodontics--examples of GIGO? Can we rely on the best trial? A comparison of individual trials and systematic reviews Sources of evidence for systematic reviews of interventions in diabetes. Mineral Trioxide Aggregate vs. Calcium Hydroxide in Primary Molar Pulpotomy: A Systematic Review Components of effective randomized controlled trials of hydrotherapy programs for fibromyalgia syndrome: A systematic review Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. Comparison of large versus smaller randomized trials for mental health-related interventions. A systematic review protocol examining the effect of vitamin D supplementation on endothelial function The use of systematic reviews in the planning, design and conduct of randomised trials: a retrospective cohort of NIHR HTA funded trials Yoga-based exercise improves health-related quality of life and mental well-being in older people: a systematic review of randomised controlled trials Effectiveness of dance in patients with fibromyalgia: a randomized, single-blind, controlled study. Maternal mental health and integrated programs for mothers with substance abuse issues. Effects of universally offered parenting interventions for parents with infants: a systematic review The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. Estimating the Horizon of Articles to Decide When to Stop Searching in Systematic Reviews: An Example Using a Systematic Review of RCTs Evaluating Osteoporosis Clinical Decision Support Tools Issues related to the conduct of systematic reviews: a focus on the nutrition field. Caries-preventive effect of glass ionomer and resin-based fissure sealants on permanent teeth: An update of systematic review evidence The effects of exercise on cognition in Parkinson’s disease: a systematic review Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy
Systematic review s , a cornerstone of evidence -based medicine , are not produced quickly enough to support clinical practice . The cost of production , availability of the requisite expertise and timeliness are often quoted as major contributors for the delay . This detailed survey of the state of the art of information systems design ed to support or automate individual tasks in the systematic review , and in particular systematic review s of r and omized controlled clinical trials , reveals trends that see the convergence of several parallel research projects . We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks of the systematic review . Several projects focus on automating , simplifying and /or streamlining specific tasks of the systematic review . Some tasks are already fully automated while others are still largely manual . In this review , we describe each task and the effect that its automation would have on the entire systematic review process , summarize the existing information system support for each task , and highlight where further research is needed for realizing automation for the task . Integration of the systems that automate systematic review tasks may lead to a revised systematic review workflow . We envisage the optimized workflow will lead to system in which each systematic review is described as a computer program that automatically retrieves relevant trials , appraises them , extracts and synthesizes data , evaluates the risk of bias , performs meta- analysis calculations , and produces a report in real time In many areas of medicine the amount of published information is increasing at an exponential rate , making it difficult for the clinician to condense the data to a manageable amount of valuable and useful information . Systematic review s have been suggested as a remedy for this information overload . Such review s are regarded as the highest level of evidence . Certain statistical methods , e.g. , meta- analysis , have also been introduced for the calculation of a more comprehensive summation of the compiled results from studies with small sample sizes . These findings would then serve as an authoritarian guide for evidence -based practice . Endodontists have lately jumped on the b and wagon of systematic review s and meta-analyses , and papers on various topics are being published . Well done , such comprehensive information would be very useful and authoritative for the practitioner . Alarmingly , the quality of these recent publications is negatively correlated to the frequency . This can have serious consequences in the clinical arena if spurious information is given a seal of approval when communicated as facts in refereed journals . A systematic literature review is design ed to focus on a single question and to synthesize all high- quality research reports relevant to the question . In these studies , however , sources of bias are often not controlled . Therefore , even the best review and meta- analysis becomes useless if it is based on poorly design ed research . Furthermore , these review s are mostly based on published data which are too often biased toward studies that show significant differences in results and /or outcome . “ Uninteresting ” conclusions tend not to be published . Endodontic literature , thus far , is short on well design ed and executed r and omized clinical trials . Furthermore , clinical protocol s often have many important “ proprietary ” modifications that make comparison difficult . This makes it very hard to undertake a systematic review to answer a narrow question . Such GIGO ( garbage in , garbage out ) can easily lead to biased conclusions and reinforce already existing biased comclusions . An example of such bias can be illustrated by a meta- analysis recently published . The study focused on assessing if there were differences in outcome between 1 and 2 treatment visits when treating teeth with apical periodontitis . Relevant publications on this topic are rare , and with the narrow inclusion criteria only 3 investigations were available for the review . However , the only factors connecting these 3 studies was the words “ single ” and “ two visits ” in the title . Beyond that , the selected studies are too different and inadequate for the study . Only 1 study is somewhat demonstrably r and omized , and outcome assessment s are based on 3 vastly different criteria . Two of the studies use calcium hydroxide as intracanal dressing , whereas the third uses no intervisit medication . Complexity of initial pathology and healing time are also clearly factors of great importance but not controlled . In addition , sample sizes in the component studies as well as the final cohort are all too small for the conclusions that there was no significant difference between 1or 2-visit treatment protocol s. To undertake and publish a meta- analysis on such an incomplete sample is counterproductive . Although the publication noted its numerous limitations , it will still communicate erroneous conclusions with a poor scientific foundation to the less informed reader . There are other examples of recently published systematic review s that are very ambiguous and tend to communicate spurious facts . One of these studies looks at the effect of smear-layer removal on sealing ability of root canal obturation . The study is entirely limited to laboratory experiments , with the majority of evaluations using dye leakage which is generally considered to be unreliable . This is an example of review ers lacking content expertise . The authors draw the conclusion , using defective review material , that removal of smear layer enhances the seal of the root filling . We may generally believe that this is the truth Background The ideal evidence to answer a question about the effectiveness of treatment is a systematic review . However , for many clinical questions a systematic review will not be available , or may not be up to date . One option could be to use the evidence from an individual trial to answer the question ? Methods We assessed how often ( a ) the estimated effect and ( b ) the p-value in the most precise single trial in a meta- analysis agreed with the whole meta- analysis . For a r and om sample of 200 completed Cochrane Review s ( January , 2005 ) we identified a primary outcome and extracted : the number of trials , the statistical weight of the most precise trial , the estimate and confidence interval for both the highest weighted trial and the meta- analysis overall . We calculated the p-value for the most precise trial and meta- analysis . Results Of 200 review s , only 132 provided a meta- analysis of 2 or more trials , with a further 35 effect estimates based on single trials . The average number of trials was 7.3 , with the most precise trial contributing , on average , 51 % of the statistical weight to the summary estimate from the whole meta- analysis . The estimates of effect from the most precise trial and the overall meta-analyses were highly correlated ( rank correlation of 0.90).There was an 81 % agreement in statistical conclusions . Results from the most precise trial were statistically significant in 60 of the 167 evaluable review s , with 55 of the corresponding systematic review s also being statistically significant . The five discrepant results were not strikingly different with respect to their estimates of effect , but showed considerable statistical heterogeneity between trials in these meta-analyses . However , among the 101 cases in which the most precise trial was not statistically significant , the corresponding meta-analyses yielded 31 statistically significant results . Conclusions Single most precise trials provided similar estimates of effects to those of the meta-analyses to which they contributed , and statistically significant results are generally in agreement . However , " negative " results were less reliable , as may be expected from single underpowered trials . For systematic review ers we suggest that : ( 1 ) key trial(s ) in a review deserve greater attention ( 2 ) systematic review ers should check agreement of the most precise trial and the meta analysis . For clinicians using trials we suggest that when a meta- analysis is not available , a focus on the most precise trial is reasonable provided it is adequately powered AIMS To analyse the effect on systematic review s in diabetes interventions of including only trials that are indexed in medline , and to assess the impact of adding trials from other data bases and the grey literature . METHODS All systematic review s of diabetes interventions which included a meta- analysis of r and omized controlled trials , and were published since 1996 , were selected . The impact on the meta- analysis of including only those trials indexed in medline , and the effect of then adding trials from other sources , was assessed . Where possible this was measured quantitatively , by redoing the meta- analysis , otherwise a qualitative estimate was made . RESULTS Forty-four systematic review s met our inclusion criteria . There were 120 articles reporting trial data which were not indexed in medline . These came from 52 % of the review s. In 34 % of the review s , basing a meta- analysis on a search of only medline would miss trials that could affect the result . Sources of non- medline data which had the biggest effect on the meta-analyses were journal articles from central and embase ( mainly in Diabetes , Nutrition and Metabolism ) and unpublished data ( mainly from industry ) . The exceptions were journal articles on herbal medicine , mostly indexed in Chinese language data bases . CONCLUSIONS A search of only the medline data base is insufficient for systematic review s of diabetes , because in about 34 % of review s the missed trials could affect the results of the meta- analysis . It is recommended that central ( on the Cochrane Library ) also be search ed . Scanning meeting abstract s , and seeking unpublished data are also recommended if the intervention has only recently been introduced Introduction : The aim of this quantitative systematic review /meta- analysis was to compare the treatment outcomes of mineral trioxide aggregate ( MTA ) and calcium hydroxide ( CH ) in pulpotomy of human primary molars . The focused PICO question was “ in case of pulp exposure in vital primary molars , how does MTA pulpotomy compare to CH in terms of clinical /radiographic success ? ” Methods and Material s : We retrieved published r and omized clinical trials ( RCTs ) of at least 6-month duration ; our search included articles published up to March 2013 in five following data bases : PubMed ( Medline ) , Cochrane data base of systematic review s , Science Citation Index , EMBASE , and Google Scholar . Mantel Haenszel and Inverse Variance-weighted methods were applied by STATA ; the relative risk ( RR ) was calculated with 95 % confidence intervals ( CI ) . Results : A total of 282 English articles were collected . Two authors independently screened the articles and five RCTs were selected ; data extraction and quality assessment were then carried out . Four RCTs were appropriate for meta- analysis according to their follow-up times by Mantel Haenszel method . Statistically significant difference was found between success rate of MTA compared to CH , with RR=0.08 ( 95 % CI , 0.02 - 0.39 ) , RR=0.19 ( 95 % CI , 0.08 - 0.46 ) , and RR=0.38 ( 95 % CI , 0.21 - 0.68 ) for 6- , 12- , and 24-month follow-ups , respectively . A significant difference was also observed for all included RCTs after analyses using the Inverse Variance-weighted method ( RR=0.44 ; 95 % CI , 0.27 - 0.72 ) . Conclusions : Systematic review /meta- analysis of included RCTs revealed that for pulpotomy of vital primary molars , MTA has better treatment outcomes compared to CH Aim Previous systematic review s have found hydrotherapy to be an effective management strategy for  fibromyalgia syndrome ( FMS ) .  The aim of this systematic review was to summarize the components of hydrotherapy programs used in r and omized controlled trials . Method A systematic review of r and omized controlled trials was conducted . Only trials that have reported significant FMS-related outcomes were included . Data relating to the components of hydrotherapy programs ( exercise type , duration , frequency and intensity , environmental factors , and service delivery ) were analyzed . Results Eleven r and omized controlled trials were included in this review . Overall , the quality of trials was good . Aerobic exercise featured in all 11 trials and the majority of hydrotherapy programs included either a strengthening or flexibility component . Great variability was noted in both the environmental components of hydrotherapy programs and service delivery . Conclusions Aerobic exercise , warm up and cool-down periods and relaxation exercises are common features of hydrotherapy programs that report significant FMS-related outcomes . Treatment duration of 60 minutes , frequency of three sessions per week and an intensity equivalent to 60%–80 % maximum heart rate were the most commonly reported exercise components . Exercise appears to be the most important component of an effective hydrotherapy program for FMS , particularly when considering mental health-related outcomes Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community ( non‐institutional care ) . Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team ‐ for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta‐analyses , systematic review s , r and omised control trials , quasi‐experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . Assessment of quality Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . Data collection and analysis St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta‐ analysis . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . Results A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty‐five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta‐ analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta‐ analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well‐being , self‐efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta‐ analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . Effectiveness of intervention type Four categories of intervention were included in the review ‐ psycho‐educational , support , multi‐component and other . Psycho‐educational Thirteen studies used  psycho‐educational interventions , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta‐ analysis . No significant impact of psycho‐educational interventions was found for the outcome categories of subjective well‐being , self‐efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta‐ analysis and demonstrated a small but significant improvement on caregiver burden . Multi‐component Twelve of the studies report multi‐component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self‐efficacy , depression , subjective well‐being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta‐ analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits .  Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on  caregiver depression was available for meta‐ analysis from eight studies . This indicated that multi‐component and psycho‐educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta‐ analysis and findings indicated that there were no significant effects of any of interventions . No meta‐ analysis was possible for the outcome categories of health , self‐efficacy or subjective well‐being . Implication s for practice From this review there is evidence to support the use of well‐ design ed psycho‐educational or multi‐component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved Encourage active participation in educational interventions for caregivers Offer individualised programs rather than group sessions Provide information on an ongoing basis , with specific information about services and coaching regarding their new role Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which : Simply refer caregivers to support groups Only provide self help material s Only offer peer INTRODUCTION The importance of physical exercise for patients with fibromyalgia ( FM ) is very clear in the literature . Dancing is a type of aerobic exercise that has great acceptance . In addition to the beneficial effects of aerobic exercise , Zumba works on motor coordination and also has socializing as a part that should be included in patients with fibromyalgia . OBJECTIVES To evaluate the effectiveness of Zumba dancing in improving pain , functional capacity , quality of sleep and quality of life of women with fibromyalgia . DESIGN A pre-post treatment design . METHODS We evaluated 19 women with fibromyalgia , selected by convenience . Data were collected in the second half of 2016 . Zumba dancing was performed twice a week for 12 weeks . Patients were evaluated at week 0 ( T0 ) and at week 12 ( T12 ) , by the following instruments : VAS ( Visual Analogic Scale ) , Likert Scale , TUG ( Timed Up an Go Test ) , 6MWT ( Six-minute Walk Test ) , FIQ ( Fibromyalgia Impact Question naire ) , PSQI ( Pittsburgh Sleep Quality Index ) , ESS ( Epworth Sleepiness Scale ) and SF-36 quality of life . RESULTS We found differences in pain ( VAST0 = 6.21 and VAST12 = 4.53 ) with p = 0.001 and in the domain physical functioning of SF36 ( T0 = 42.37 and T12 = 52.11 ) with p = 0.04 . No differences were found for the other variables between the times . CONCLUSION Zumba dancing as a form of treatment for three months for patients with fibromyalgia was effective in improving pain and physical functioning . Future controlled and r and omized clinical trials should be performed to improve the evidence of Zumba dancing in women with fibromyalgia OBJECTIVES The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . INCLUSION CRITERIA Types of participants Adult caregivers who provide support for people with dementia living in the community ( non-institutional care).Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta-analyses , systematic review s , r and omised control trials , quasi-experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . SEARCH STRATEGY The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . ASSESSMENT OF QUALITY Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . DATA COLLECTION AND ANALYSIS St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta- analysis . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . RESULTS A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty-five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta- analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta- analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well-being , self-efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta- analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . EFFECTIVENESS OF INTERVENTION TYPE Four categories of intervention were included in the review - psycho-educational , support , multi-component and other . Psycho-educational Thirteen studies used  psycho-educational interventions  , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta- analysis . No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being , self-efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta- analysis and demonstrated a small but significant improvement on caregiver burden . Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy , depression , subjective well-being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta- analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits . Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . EFFECTIVENESS OF INTERVENTIONS USING SPECIFIC OUTCOME CATEGORIES In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on caregiver depression was available for meta- analysis from eight studies . This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta- analysis and findings indicated that there were no significant effects of any of interventions . No meta- analysis was possible for the outcome categories of health , self-efficacy or subjective well-being . IMPLICATION S FOR PRACTICE From this review there is evidence to support the use of well- design ed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Factors which do not appear to have benefit in interventions are those which OBJECTIVE The extent of disagreement between large and smaller r and omized , controlled trials on mental health issues is unknown . The authors aim ed to compare the results of large versus smaller trials on mental health-related interventions . METHOD The authors screened 161 Cochrane and 254 Data base of Abstract s of Review s of Effectiveness systematic review s on mental health-related interventions . They identified 16 meta-analyses with at least one " large " r and omized trial with sample size > 800 and at least one " smaller " trial .  Effect sizes were calculated separately for large and smaller trials . Heterogeneity was assessed between all studies , within each group ( large and smaller studies ) , and between large and smaller studies . RESULTS Significant between- study heterogeneity was seen in five meta-analyses . By r and om-effects calculations , the results of large and smaller trials differed beyond chance in four meta-analyses ( 25 % ) . In three of these disagreements ( effect of day care on IQ , discontinuation of antidepressants , risperidone versus typical antipsychotics for schizophrenia ) , the smaller trials showed greater effect sizes than the large trials . The inverse was seen in one case ( olanzapine versus typical antipsychotics for schizophrenia ) . With fixed-effects models , disagreements beyond chance occurred in five cases ( 31 % ) . In four meta-analyses , the effect size differed over twofold between large and smaller trials . Various quality and design parameters were identified as potential explanations for some disagreements . CONCLUSIONS Large trials are uncommon in mental health . Their results are usually comparable with the results of smaller studies , but major disagreements do occur . Both large and smaller trials should be scrutinized as they offer a continuum of r and omized evidence Introduction Vitamin D has potential benefits for extraskeletal health . These could include an anti-inflammatory effect as well as a reduction in endothelial dysfunction . We aim to provide quality evidence for the hypothesis that supplementation with vitamin D will improve endothelial function ( EF ) , possibly through the abrogation of systemic inflammation . Methods and analysis We will conduct a systematic review of all r and omised controlled trials on  vitamin D supplementation and EF lasting 12 weeks or more . The search will cover the period 2000–2015 and include studies that describe direct measures of EF  , markers of endothelial cell ( EC ) activation  and if concurrently reported , indicators of systemic inflammation  . Study selection will follow the Preferred Reporting Items for Systematic Review s and Meta-Analyses ( PRISMA ) guidelines and study quality will be assessed by the Jadad score in addition to an evaluation of allocation concealment and data analysis . If sufficient data are available , a meta- analysis will be conducted . The effect sizes will be generated using Hedges ’ g score , for both fixed and r and om effect models . I2 statistics and Galbraith plots will be used to assess heterogeneity and identify their potential sources . Potential publication and small sample size bias will be assessed by visual inspections of funnel plots and also Egger 's test . Meta-regression analysis ( if feasible ) will be conducted with restricted maximum likelihood ( REML ) estimation method , controlling for potential confounders ( demographics , study methods , location , etc ) . A backward elimination process will be applied in the regression modelling procedure . Subgroup analysis , conditional on number of studies retrieved and their sample size , will be stratified on participant disease category , total dose administered , degree of 25(OH)D change and type of supplement used . Ethics and dissemination Formal ethical approval is not required as primary data will not be collected . The results will be disseminated through a peer- review ed publication , conference presentation and the popular press . Trial registration number International Prospect i ve Register for Systematic Review s ( PROSPERO ) number CRD42014013523 Background A systematic review , with or without a meta- analysis , should be undertaken to determine if the research question of interest has already been answered before a new trial begins . There has been limited research on how systematic review s are used within the design of new trials , the aims of this study were to investigate how systematic review s of earlier trials are used in the planning and design of new r and omised trials . Methods Documentation from the application process for all r and omised trials funded by the National Institute for Health Research Health Technology Assessment ( NIHR HTA ) between 2006 and 2008 were obtained . This included the : commissioning brief ( if appropriate ) , outline application , minutes of the Board meeting in which the outline application was discussed , full application , detailed project description , referee comments , investigator response to referee comments , Board minutes on the full application and the trial protocol . Data were extracted on references to systematic review s and how any such review s had been used in the planning and design of the trial . Results 50 r and omised trials were funded by NIHR HTA during this period and documentation was available for 48 of these . The cohort was predominately individually r and omised parallel trials aim ing to detect superiority between two treatments for a single primary outcome . 37 trials ( 77.1 % ) referenced a systematic review within the application and 20 of these ( i.e. 41.7 % of the total ) used information contained in the systematic review in the design or planning of the new trial . The main areas in which systematic review s were used were in the selection or definition of an outcome to be measured in the trial ( 7 of 37 , 18.9 % ) , the sample size calculation ( 7 , 18.9 % ) , the duration of follow up ( 8 , 21.6 % ) and the approach to describing adverse events ( 9 , 24.3 % ) . Boards did not comment on the presence/absence or use of systematic review s in any application . Conclusions Systematic review s were referenced in most funded applications but just over half of these used the review to inform the design . There is an expectation from funders that applicants will use a systematic review to justify the need for a new trial but no expectation regarding further use of a systematic review to aid planning and design of the trial . Guidelines for applicants and funders should be developed to promote the use of systematic review s in the design and planning of r and omised trials , to optimise delivery of new studies informed by the most up-to- date evidence base and to minimise waste in research OBJECTIVE health-related quality of life ( HRQOL ) and mental well-being are associated with healthy ageing . Physical activity positively impacts both HRQOL and mental well-being .  Yoga is a physical activity that can be modified to suits the needs of older people and is growing in popularity . We conducted a systematic review with meta- analysis to determine the impact of yoga-based exercise on  HRQOL and mental well-being in people aged 60 + . METHODS search es were conducted for relevant trials in the following electronic data bases ; MEDLINE , EMBASE , Cochrane Central Register of Controlled Trials , CINAHL , Allied and Complementary Medicine Data base , PsycINFO and the Physiotherapy Evidence Data base ( PEDro ) from inception to January 2017 . Trials that evaluated the effect of physical yoga on HRQOL and /or on mental well-being  in people aged 60 + years were included . Data on HRQOL and mental well-being were extracted . St and ardised mean differences and 95 % confidence intervals ( CI ) were calculated using r and om effects models . Method ological quality of trials was assessed using the PEDro scale . RESULTS twelve trials of high method ological quality ( mean PEDro score 6.1 ) , totalling 752 participants , were identified and provided data for the meta- analysis . Yoga produced a medium effect on HRQOL ( Hedges ' g = 0.51 , 95 % CI 0.25 - 0.76 , 12 trials ) and a small effect on mental well-being ( Hedges ' g = 0.38 , 95 % CI 0.15 - 0.62 , 12 trials ) . CONCLUSION yoga interventions result ed in small to moderate improvements in both HRQOL and mental well-being in people aged 60 + years . Further , research is needed to determine the optimal dose of yoga to maximise health impact . PROSPERO REGISTRATION NUMBER ( CRD42016052458 ) OBJECTIVES The aim of the present study was to assess the effectiveness of belly dance as a treatment option for patients with fibromyalgia . METHODS Eighty female patients with fibromyalgia between 18 to 65 years were r and omly allocated to a dance group ( n=40 ) and control group ( n=40 ) . Patients in the dance group underwent 16 weeks of belly dance twice a week , while the patients in the control group remained on a waiting list . The patients were evaluated with regard to pain ( VAS ) , function ( 6MWT ) , quality of life ( FIQ and SF-36 ) , depression ( Beck Inventory ) , anxiety ( STAI ) and self-image ( BDDE ) . Evaluations were carried out at baseline , 16 weeks and 32 weeks by a blinded assessor . RESULTS The dance group achieved significant improvements in VAS for pain ( p<0.001 ) , six-minute walk test ( p<0.001 ) , FIQ ( p=0.003 ) , BDDE ( p<0.009 ) as well as the pain ( p<0.001 ) , emotional aspects ( p<0.003 ) and mental health ( p<0.021 ) subscales on the SF-36 . CONCLUSIONS Belly dance can be used in the treatment of fibromyalgia to reduce pain and improve functional capacity , quality of life and self-image To examine the impact of integrated treatment programs ( those with substance use treatment and pregnancy- , parenting- , or child-related services ) on  maternal mental health  , we compiled a data base of studies of  integrated programs published between 1990 and 2007 with outcome data on maternal mental health . There were 18 cohort studies , 3 r and omized trials , and 2 quasi-experimental studies . Of the five studies comparing integrated to nonintegrated programs , three studies provided enough information to allow for them to be combined in a meta- analysis . The average effect size was 0.23 ( 95 % CI = 0.15 to 0.31 , SE = 0.04 ) , p < .001 . There was no statistically significant heterogeneity among the studies , Q = 5.66 , p = .059 . This meta- analysis is the first systematic quantitative review of studies evaluating the impact of integrated programs on maternal mental health . Findings suggest that integrated programs may be associated with a small advantage over nonintegrated programs in improving maternal mental health . This review highlights the need for further research with improved methodology , study quality , and reporting to improve our underst and ing of how best to meet the mental health needs of mothers with substance abuse issues Objectives From a developmental perspective , infancy is a critical stage of life . Early childhood interventions aim to support caretakers , but the effects of universal interventions for parents with infants are unknown . The objective is to determine the effects of universal parenting interventions offered to parents with infants 0–12 months on measures of child development and parent – child relationship . Design A systematic review using the Preferred Reporting Items for Systematic Review s and Meta- Analysis . We extracted publications from 10 data bases in June 2013 , January 2015 and June 2016 and supplemented with grey and h and search . Risk of bias was assessed , and effect sizes were calculated . Participants Inclusion criteria are : ( 1 ) r and omised controlled trials of structured , psychosocial interventions offered to a universal population of parents with infants 0–12 months old in western OECD countries , ( 2 ) interventions that include a minimum of 3 sessions with at least half of the sessions delivered postnatally and ( 3 ) programme outcomes reported for child development or parent – child relationship . Results 14 papers representing 7 studies are included . There were no statistically significant effects of the intervention for the majority of the primary outcomes across the studies . Conclusions The findings of this review are mixed . No clear conclusions can be drawn regarding the effects of universally offered parenting interventions on child development and parent – child relationship for this age group BACKGROUND AND OBJECTIVE Publication bias and other sample size effects are issues for meta-analyses of test accuracy , as for r and omized trials . We investigate limitations of st and ard funnel plots and tests when applied to meta-analyses of test accuracy and look for improved methods . METHODS Type I and type II error rates for existing and alternative tests of sample size effects were estimated and compared in simulated meta-analyses of test accuracy . RESULTS Type I error rates for the Begg , Egger , and Macaskill tests are inflated for typical diagnostic odds ratios ( DOR ) , when disease prevalence differs from 50 % and when thresholds favor sensitivity over specificity or vice versa . Regression and correlation tests based on functions of effective sample size are valid , if occasionally conservative , tests for sample size effects . Empirical evidence suggests that they have adequate power to be useful tests . When DORs are heterogeneous , however , all tests of funnel plot asymmetry have low power . CONCLUSION Existing tests that use st and ard errors of odds ratios are likely to be seriously misleading if applied to meta-analyses of test accuracy . The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects Research ers conducting systematic review s need to search multiple bibliographic data bases such as MEDLINE and EMBASE . However , research ers have no rational search stopping rule when looking for potentially-relevant articles . We empirically tested a stopping rule based on the concept of  capture-mark-recapture ( CMR ) , which was first pioneered in ecology . The principles of CMR can be adapted to systematic review s and meta-analyses to estimate the Horizon of articles in the literature with its confidence interval . We retrospectively tested this Horizon Estimation using a systematic review of r and omized controlled trials ( RCTs ) that evaluated clinical decision support tools for osteoporosis disease management . The Horizon Estimation was calculated based on 4 bibliographic data bases that were included as the main data sources for the review in the following order : MEDLINE , EMBASE , CINAHL , and EBM Review s. The systematic review captured 68 % of known articles from the 4 data sources , which represented 592 articles that were estimated as missing from the Horizon Systematic review s ( SRs ) are an increasingly popular evidence -based tool and are often used to answer complex research questions across many different research domains . Early SR methodology was advanced by social scientists , and the term meta- analysis was coined by a social scientist who also conducted research in psychology . SRs have recently become popular in healthcare and are likely to be beneficial in any field . The aim of this report is to highlight issues in SR conduct with a focus on the field of nutrition and to make recommendations on improving SR conduct in this area . Development of the research question is probably the most important step in conducting an SR . The 4 main components of an answerable question are 1 ) the patient , population , or problem ; 2 ) the intervention , independent variable , or exposure ; 3 ) the comparators ; and 4 ) the dependent variables or outcomes of interest . The question will be used to determine the optimal methods for conducting the SR . SRs often include study design s beyond r and omized trials and do not always include a meta- analysis of the results . Other topics explored include underst and ing and interpreting discordant review s and the importance of reporting tools [ eg , QUality Of Reporting Of Meta-analyses ( QUOROM Statement ) or CONsoli date d St and ards Of Reporting of Trials ( CONSORT Statement ) ] . Recommendations are then provided , such as developing a capacity-building program , search ing the primary literature for research gaps , and extending reporting tools such as the QUOROM Statement to the field of nutrition Background This article constitutes a partial up date of the original systematic review evidence by Yengopal et al. from 15 January 2008 ( published in the Journal of Oral Science in 2009 ) with primary focus on research quality in regard to bias risk in trials . Its aim is to up date the existing systematic review evidence from the English literature as to whether caries occurrence on pits and fissures of teeth sealed with either GIC or resin is the same . Methods In addition to the 12 trials included during the original systematic review , 5 new trials were identified during the data base search ( up to 26 August 2010 ) and 2 further trials were included from a h and search and reference check . Of these , 3 trials were excluded and 16 were accepted for data extraction and quality assessment . The quality of accepted trials was assessed , using up date d quality criteria , and the risk of bias was investigated in more depth than previously reported . In addition , the focus of quantitative synthesis was shifted to single data sets that were extracted from the accepted trials . Results Twenty-six dichotomous and 4 continuous data sets were extracted . Meta- analysis and cumulative meta- analysis were used in combining clinical ly homogenous data sets . The overall outcome of the computed data sets suggest no difference between the caries-preventive effects of GIC- and resin-based fissure sealants . Conclusions This overall outcome is in agreement with the conclusions of the original systematic review . Although the findings of the trials identified in this up date may be considered to be less affected by attrition- and publication bias , their risk of selection - and detection-/performance bias is high . Thus , verification of the currently available results requires further high quality r and omised control trials Cognitive impairments are highly prevalent in Parkinson ’s disease ( PD ) and can substantially affect a patient ’s quality of life . These impairments remain difficult to manage with current clinical therapies , but exercise has been identified as a possible treatment . The objective of this systematic review was to accumulate and analyze evidence for the effects of exercise on cognition in both animal models of PD and human disease . This systematic review was conducted according to the Preferred Reporting Items for Systematic review s and Meta-Analyses ( PRISMA ) statement . Fourteen original reports were identified , including six pre- clinical animal studies and eight human clinical studies . These studies used various exercise interventions and evaluated many different outcome measures ; therefore , only a qualitative synthesis was performed . The evidence from animal studies supports the role of exercise to improve cognition in humans through the promotion of neuronal proliferation , neuroprotection and neurogenesis . These findings warrant more research to determine what roles these neural mechanisms play in clinical population s. The reports on cognitive changes in clinical studies demonstrate that a range of exercise programs can improve cognition in humans . While each clinical study demonstrated improvements in a marker of cognition , there were limitations in each study , including non-r and omized design s and risk of bias . The Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system was used and the quality of the evidence for human studies were rated from “ low ” to “ moderate ” and the strength of the recommendations were rated from “ weak ” to “ strong ” . Studies that assessed executive function , compared to general cognitive abilities , received a higher GRADE rating . Overall , this systematic review found that in animal models exercise  results in behavioral and corresponding neurobiological changes in the basal ganglia related to cognition . The clinical studies showed that various types of exercise , including aerobic , resistance and dance can improve cognitive function , although the optimal type , amount , mechanisms , and duration of exercise are unclear . With growing support for exercise to improve not only motor symptoms , but also cognitive impairments in PD , health care providers and policy makers should recommend exercise as part of routine management and neurorehabilitation for this disorder Background To improve quality of care and patient outcomes , health system decision-makers need to identify and implement effective interventions . An increasing number of systematic review s document the effects of quality improvement programs to assist decision-makers in developing new initiatives . However , limitations in the reporting of primary studies and current meta- analysis methods ( including approaches for exploring heterogeneity ) reduce the utility of existing syntheses for health system decision-makers . This study will explore the role of innovative meta- analysis approaches and the added value of enriched and up date d data for increasing the utility of systematic review s of complex interventions . Methods / Design We will use the data set from our recent systematic review of 142 r and omized trials of diabetes quality improvement programs  to evaluate novel approaches for exploring heterogeneity . These will include exploratory methods , such as multivariate meta-regression analyses and all-subsets combinatorial meta- analysis . We will then up date our systematic review to include new trials and enrich the data set by surveying authors of all included trials . In doing so , we will explore the impact of variables not , reported in previous publications , such as details of study context , on the effectiveness of the intervention . We will use innovative analytical methods on the enriched and up date d data set to identify key success factors in the implementation of  quality improvement interventions  for diabetes . Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results . Discussion This study will inform future systematic review s of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta- analysis . It will also result in an up date d comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes . Systematic review registration PROSPERO registration no. Background Experimenter ’s allegiance ( EA ) refers to a personal confidence of the superiority of a specific psychotherapy treatment . This factor has been linked with larger treatment effects in favor of the preferred treatment . However , various studies have displayed contradictory results between EA and the pattern of treatment effects . Aims Using a systematic approach followed by meta- analysis , we aim ed to evaluate the impact of an allegiance effect on the results of psychotherapeutic studies . Method We considered the meta-analyses of r and omized controlled trials ( RCTs ) of different types of psychotherapies in the Cochrane Data base of Systematic Review s. Eligible articles included meta-analyses of RCTs with at least one study showing evidence of EA ( i.e. , allegiant study ) . Effect sizes in allegiant RCTs were compared with non-allegiant using r and om and fixed models and a summary relative odds ratio ( ROR ) were calculated . Heterogeneity was quantified with the I2 metric . Results A total of 30 meta-analyses including 240 RCTs were analyzed . The summary ROR was 1.31 [ ( 95 % confidence interval ( CI : 1.03–1.66 ) P = 0.30 , I2 = 53 % ] indicating larger effects when allegiance exists . The impact of allegiance did not differ significantly ( P > 0.05 ) when we compared psychiatric versus medical outcomes . Allegiance effect was significant for all forms of psychotherapy except for cognitive behavioral therapy . Moreover , the impact of allegiance was significant only when the treatment integrity of delivered psychotherapy was not assessed . Allegiance effect was even stronger where the experimenter was also both the developer of the preferred treatment and supervised or trained the therapists . No significant differences were found between allegiant and non-allegiant studies in terms of overall quality of studies . Conclusions Experimenter ’s allegiance influences the effect sizes of psychotherapy RCTs and can be considered non-financial conflict of interest introducing a form of optimism bias , especially since blinding is problematic in this kind of research . A clear reporting of EA in every single study should be given an opportunity to investigators of minimizing its overestimation effects
In addition , significant improvements were observed in quality of life , depression , impact of the disease , anxiety , and physical function .
Conclusion Dance-based intervention programs can be an effective intervention for people suffering from fibromyalgia , leading to a significant reduction of the level of pain with an effect size that can be considered as large .
Objective The aim of this study was to perform a systematic review on the effectiveness of dance-based programs in patients with fibromyalgia , as well as calculate the overall effect size of the improvements , through a meta- analysis .