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Aim: To assess the effectiveness of decision aids in the treatment, prevention and screening of breast cancer patients. Design: A systematic review and meta‐analysis. Methods: The review protocol was registered in the CRD Prospero database(CRD42020173028). A literature search was carried out in five databases: PubMed, Cochrane, EMBASE, Scopus and Web of science data in January 2020. We used The Cochrane risk bias assessment tool to evaluate the literature quality of included trials and the Review Manager 5.2 software to analyse data. Results: We included 22 studies. Compared with the conventional methods, decision aids reduced treatment decision conflicts and had no significant effect on screening decision conflicts (WMD=−2.25, 95% CI = ‐ 2.64,‐1.87, p <.0001; WMD=−1.37, 95% CI = ‐ 3.57,0.83, p =.22). Three were no statistical differences in participants' anxiety, decision regret, knowledge, informed choice and decision‐making satisfaction between the two groups. [ABSTRACT FROM AUTHOR]

Background: The effects of acupuncture on Alzheimer's disease (AD) outcomes remain controversial. The aim of this review was to evaluate the effectiveness and safety of acupuncture for the treatment of AD. Methods: PubMed, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, Chinese BioMedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang Data were searched to identify relevant randomized controlled trials from inception to January 19, 2019. Data were extracted and evaluated by two authors independently. The data analysis was conducted using R (version 3.6.0) and RStudio (version 1.2.1335) software. Results: Thirty trials involving 2,045 patients were included. Acupuncture plus drug therapy may have been more beneficial for general cognitive function in AD patients than drug therapy alone (short-term treatment: MD, mean difference = 1.94, 95% CI: 1.11, 2.77; p < 0.01; medium-term treatment: MD = 4.41, 95% CI: 1.83, 7.00; p < 0.01). People who received acupuncture plus drug therapy attained higher ADL (Activities of Daily Living) scores than patients who received drug therapy alone for medium-term treatment duration (MD = −2.14; 95% CI: −3.69, −0.59; p < 0.01). However, there is no statistically significant difference in subgroup effect on MMSE (Mini-mental Status Examination) and ADLs (p > 0.05) when comparing acupuncture treatment with drug therapy (such as Donepezil hydrochloride, Nimodipine, or Yizhijiannao), or acupuncture plus drug therapy (such as Donepezil hydrochloride, Dangguishaoyaosan, or Jiannaosan) with drug therapy alone. There was also no significant difference in general cognitive function, ADLs, or incidence of adverse events between acupuncture treatment and drug therapy (p > 0.05). Conclusions: This review indicates that acupuncture plus drug therapy may have a more beneficial effect for AD patients than drug therapy alone on general cognitive function in the short and medium term and on ADLs in the medium term. Acupuncture alone may not have superior effects compared with drug therapy on global cognitive function, ADLs, and incidence of adverse events. Duration of treatment may not modify the effect of acupuncture in comparison with drug therapy. Additional large-scale and high-quality clinical trials are needed. [ABSTRACT FROM AUTHOR]

Objective: Many published studies have investigated the association between CYP17 rs743572 polymorphism and benign prostatic hyperplasia (BPH) susceptibility but have yielded inconsistent results. Hence, we performed this meta-analysis using the multivariate statistic method to address a more precise association. Methods: Case-control or cohort studies with adequate genotype distribution or minor allele frequency (MAF) were identified by searching the PubMed, Embase, and Web of Science databases up to December, 2018. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate the association between CYP17 rs743572 polymorphism and BPH susceptibility. Results: Pooled MAFs of 13 studies were 37% in Caucasians and 56% in Orientals, respectively. Pooled results of 8 studies suggested that CYP17 rs743572 was not associated with the BPH susceptibility in the overall population (OR = 0.98, 95% CI: 0.80–1.20 for A2 vs. A1; OR = 0.99, 95% CI: 0.79–1.25 for A1/A2 vs. A1/A1; OR = 0.97, 95% CI: 0.62–1.53 for A2/A2 vs. A1/A1). Sensitivity analysis showed the results were robust. Subgroup analysis based on ethnicity suggested that, in Orientals, A2 allele carriers had a 28% lower risk of developing BPH compared with A1 allele carriers, and the risk of BPH is 47% lower in A2/A2 genotype carriers compared with A1/A1 genotype carriers. No significant association was observed in Caucasians. Conclusion: In conclusion, our study indicates a negative association between CYP17 and BPH in Orientals. However, due to limited sample size, the conclusion should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Objective: Chronic periodontitis (CP) is a growing problem that affects the worldwide population, having significant impacts on people's daily lives and economic development. Genetics is an important component in the determination of individual susceptibility to periodontal diseases. Numerous studies have been performed to investigate the association between beta defensin 1 (DEFB1) rs11362 polymorphism and risk of CP, but the results are still inconclusive. Therefore, we conducted this meta-analysis to ascertain whether this variation in DEFB1 is associated with CP susceptibility. Methods: The relevant studies were searched in PubMed and Chinese National Knowledge Infrastructure (CNKI) databases up to January 9, 2018. Two independent authors selected citations and extracted the data from eligible studies. Odds ratios (ORs) with their 95% confidence intervals (95% CIs) were used to assess the strength of the association. Results: Seven case-control studies were included in this meta-analysis. Based on unadjusted data, there was no obvious association between DEFB1 rs11362 polymorphism and CP risk in all genetic models (A vs. G: OR = 0.86, 95%CI = 0.61–1.20; AA vs. GG: OR = 0.83, 95% CI = 00.50–1.39; AG vs. GG: OR = 1.01, 95%CI = 0.73–1.39; AG+AA vs. GG: OR = 0.91, 95% CI = 00.74–1.11; and AA vs. AG+GG: OR = 0.83, 95% CI = 00.57–1.21); the results of adjusted data also showed no significant relationship. Subgroup analyses based on ethnicity, participants' smoking status, HWE in controls and severity of CP all revealed similar results to that of the overall analysis. Sensitivity analysis indicated the results were robust and no evidence of publication bias was found. Conclusions: Our meta-analysis suggests that DEFB1 rs11362 polymorphism may not have an important effect on the risk of CP. Further large-scale and well-designed studies are necessary to validate our conclusion in the future. [ABSTRACT FROM AUTHOR]

Background: About 75% of newly diagnosed bladder cancer cases suffer from non-muscle invasive bladder cancer (NMIBC), which used to recur and progress despite transurethral resection of bladder tumor (TURBT). This meta-analysis was conducted to examine if combined application of intravesical bacille Calmette-Guérin (BCG) with chemotherapy is associated with better prognosis. Methods: Systematic searches of randomized controlled trials (RCTs) concerning NMIBC were performed in PubMed, EMbase, CENTRAL, CNKI, WanFang, VIP, CBM databases, and some specialized websites. Two researchers independently implemented study selection, quality assessment and data extraction. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for treatment effects on recurrence-free survival (RFS), progression-free survival (PFS), overall survival (OS) and disease-specific survival (DSS) were directly extracted, if available, or estimated using relevant data from included studies. Side effects, such as fever, gastrointestinal reaction, cystitis, irritative bladder symptoms and hematuria, were also extracted as outcome measurements, and associated relative risks (RRs) were calculated to assess treatment safety. RevMan 5.3 software was used to perform statistical analyses. Results: Thirteen RCTs containing 1,754 patients with NMIBC were included in this meta-analysis. Compared with BCG alone, the combination therapy significantly improved RFS (HR = 0.53, 95% CI: 0.43–0.66, P < 0.01), OS (HR = 0.66, 95%CI: 0.50–0.86, P = 0.002), and DSS (HR = 0.48, 95%CI: 0.29–0.80, P = 0.005). While PFS showed no obvious difference between combination therapy and BCG alone (HR = 0.65, 95%CI: 0.25–1.68, P = 0.38). The rate of fever (RR = 0.50, 95%CI: 0.27–0.91, P = 0.02), irritative bladder symptoms (RR = 0.69, 95%CI: 0.52–0.90, P = 0.007) and hematuria (RR = 0.50, 95%CI: 0.28–0.89, P = 0.02) were significantly decreased in patients treated with combination therapy compared to those with BCG alone. There were no statistically significant differences between combination therapy and BCG alone in toxicity (RR = 0.69, 95%CI: 0.34–1.40, P = 0.30), gastrointestinal reaction (RR = 2.54, 95%CI: 0.61–10.60, P = 0.20) or cystitis (RR = 0.67, 95%CI: 0.29–1.54, P = 0.34). Conclusions: Combined application of intravesical BCG and chemotherapy appears to be an effective treatment for patients with intermediate- to high-risk NMIBC, but not for those with tumor in situ alone or recurrent bladder cancer. [ABSTRACT FROM AUTHOR]

Objective: It has been reported that the periodontal disease is linked to a number of malignant tumors such as lung cancer and pancreatic cancer. In this study, we aimed to investigate the association of periodontal disease with risk of bladder cancer by a meta-analysis. Methods: PubMed, Scopus, ScienceDirect, and Chinese National Knowledge Infrastructure (CNKI) were searched for eligible publications up to December 15, 2017. Cohort and nested case-control studies on the association between periodontal disease and risk of bladder cancer were included. After study selection and data extraction, pooled hazard ratios (HRs) and their 95% confidence intervals (95%CIs) were calculated using a fixed-effect inverse-variance model. All analyses were performed using the RevMan 5.3 software. Results: Finally, five cohort studies were identified and included in this meta-analysis, involving 1,104 bladder cancer cases of 298,476 participants. Summary estimates based on adjusted data showed that periodontal disease was not significantly associated with the risk of bladder cancer (HR = 1.09, 95% CI = 0.95–1.25, I2 = 0%). A similar result was also observed after cumulative, subgroup and sensitivity analyses. Conclusions: Current evidence from cohort studies suggests that patients with periodontal disease may not be at an increased risk of developing bladder cancer. [ABSTRACT FROM AUTHOR]

The aim of this paper was to evaluate reporting and methodological quality of systematic reviews or meta-analyses in the nursing field in China. Over the last decade, evidence-based nursing has been gradually known and accepted by nurses in China, and the number of systematic reviews or meta-analyses of nursing flied has steadily increased, but the quality of these reviews is unsatisfactory. The Chinese Journal Full-Text Database, the Chinese Biomedicine Literature Database and the Wanfang Database were searched for systematic reviews or meta-analyses in the nursing field, from inception through December 2011. The Preferred Reporting Items of Systematic Reviews and Meta-analyses and the Assessment of Multiple Systematic Reviews checklists were used to assess reporting characteristics and methodological quality, respectively. A total of 63 systematic reviews or meta-analyses were identified. The deficiencies of methodological quality were mainly in literature searches, heterogeneity handling, recognition and assessment of publication bias. In addition, the deficiencies of reporting characteristics were reflected in incomplete reporting of literature search, quality assessment, risk of bias and results. Focusing on improving the quality of reporting and methodological quality of systematic reviews or meta-analyses in the nursing field in China is urgently needed. [ABSTRACT FROM AUTHOR]

[Display omitted] High heterogeneity has been reported among epidemiological studies exploring the relationship between metformin and the risk of gastric cancer. Immortal time bias might be one of the vital factors causing heterogeneity because of its widespread existence in pharmacological observational studies and it could severely exaggerate the drug's effectiveness. Immortal time bias could occur in an observational study if exposure status is determined based on a measurement or event that occurs after baseline. In this study, we aimed to assess whether immortal time bias is responsible for the false assumption that metformin reduces the risk of gastric cancer. We searched PubMed, Embase, Web of Science and Cochrane Library databases for relevant studies from the inception to August 9, 2020. The strength of the relationship was assessed using pooled relative risks (RRs) with corresponding 95% confidence intervals (95% CIs). Statistical analyses were carried out using a random-effects model. Pooled RR from 6 cohort studies with immortal time bias found a clear 33% reduced risk associated with metformin use (RR = 0.67, 95% CI = 0.59, 0.77; P < 0.001; I2 = 48.5%). However, pooled RR from 8 cohort studies without immortal time bias indicated no association between the use of metformin and gastric cancer risk (RR = 0.95, 95% CI = 0.85, 1.05; P = 0.317; I2 = 64.5%). From a univariate meta-regression model, the presence of immortal time bias was associated with a significant reduction of 29% in the effect estimate of metformin on gastric cancer risk (ratio of RR = 0.71, 95% CI = 0.58, 0.86; P = 0.002). This meta-analysis indicates that metformin use has no protective effect on gastric cancer risk. The relationship between metformin use and gastric cancer risk has been exaggerated as a result of the presence of immortal time bias. Further studies are required to confirm the results by controlling for immortal time bias based on appropriate study designs and statistical methods. [ABSTRACT FROM AUTHOR]