PMC:99047 / 8105-16670 JSONTXT

{"project":"2_test","denotations":[{"id":"11914146-11513758-13185081","span":{"begin":905,"end":906},"obj":"11513758"},{"id":"11914146-10688558-13185082","span":{"begin":937,"end":938},"obj":"10688558"},{"id":"11914146-11518548-13185083","span":{"begin":987,"end":988},"obj":"11518548"},{"id":"11914146-1824710-13185084","span":{"begin":1133,"end":1135},"obj":"1824710"},{"id":"11914146-10938031-13185085","span":{"begin":1181,"end":1182},"obj":"10938031"},{"id":"11914146-7742666-13185086","span":{"begin":1226,"end":1227},"obj":"7742666"},{"id":"11914146-9746022-13185087","span":{"begin":1366,"end":1368},"obj":"9746022"},{"id":"11914146-11527508-13185088","span":{"begin":1439,"end":1440},"obj":"11527508"},{"id":"11914146-11004423-13185089","span":{"begin":1545,"end":1547},"obj":"11004423"},{"id":"11914146-11868441-13185090","span":{"begin":1663,"end":1664},"obj":"11868441"},{"id":"11914146-11072941-13185091","span":{"begin":1713,"end":1715},"obj":"11072941"},{"id":"11914146-1834807-13185092","span":{"begin":1748,"end":1750},"obj":"1834807"},{"id":"11914146-11914145-13185093","span":{"begin":1833,"end":1835},"obj":"11914145"}],"text":"Results\nWe screened 479 potentially relevant articles. Of these 432 failed to meet our inclusion criteria, or were otherwise unusable. The vast majority of reports were excluded (84%) because they did not include any randomized trial involving children (Figure 1).\nFigure 1 Flow of citations and articles through the phases of screening and eligibility evaluation. The reviews were recent with 1998 being the median year of publication. Diseases of the nervous system and sense organs, mental disorders, and respiratory system were the most common ICD categories investigated (Table 2). Psychotherapy and vitamins were the most common interventions examined (Table 3).\nTable 2 Freqency of international classification of disease (ICD) categories investigated in systematic reviews of pediatric complementary and alternative medicine\nICD category N %\nDiseases of the nervous system and sense organs [6] 13 27.7%\nMental disorders [5] 12 25.5%\nDiseases of the respiratory system [8] 10 21.3%\nDiseases of the musculoskeletal system and connective tissue [13] 6 12.8%\nCertain conditions originating in the perinatal period [15] 6 12.8%\nDiseases of the digestive system [9] 5 10.6%\nIntestinal infectious diseases [1] 4 8.5%\nEndocrine, nutritional and metabolic diseases and immunity disorders [3] 4 8.5%\nDiseases of the skin and subcutaneous tissue [12] 4 8.5%\nNeoplasm's (2) 3 6.4%\nDiseases of the circulatory system [7] 2 4.3%\nInjury and poisoning [17] 2 4.3%\nComplications of pregnancy, childbirth and the puerperium [11] 1 2.1%\nSymptoms, signs and ill-defined conditions [16] 1 2.1%\nDiseases of the blood and blood-forming organs [4] 0 0.0%\nDiseases of the genitourinary system [10] 0 0.0%\nCongenital anomalies [14] 0 0.0%\nSupplemental classification of external causes of injury and poisoning [18] 0 0.0%\nSupplementary classification of factors influencing health status and contact with health services [19] 0 0.0%\nTable 3 Freqency of interventions investigated in systematic reviews of pediatric complementary and alternative medicine\nIntervention used\nPsychotherapy 8 17.0%\nVitamins 8 17.0%\nBehavioral interventions 4 8.5%\nEnergy healing 4 8.5%\nMassage 4 8.5%\nHerbs 3 6.4%\nHomeopathy 3 6.4%\nHypnosis 3 6.4%\nAcupuncture 2 4.3%\nBiofeedback 2 4.3%\nDrugs (as well as some CAM therapy) 2 4.3%\nExercise 2 4.3%\nLifestyle diet 2 4.3%\nMegavitamins 2 4.3%\nNon-nutritive sucking 2 4.3%\nRelaxation 2 4.3%\nSpiritual healing by others 2 4.3%\nChiropractic 1 2.1%\nArt/music therapy 0 0.0%\nFolk remedies 0 0.0%\nSelf-Help group 0 0.0%\nSelf-Prayer 0 0.0%\nOther 7 14.9% The median number of primary studies included in the reviews was 12, of which 9 (median) included children. The median number of participants was 604, of which 362 (median) were children. Although 40% of the reviews were limited to children only, another 32% of the reviews did not provide separate results for children included. Only 2 (of 47) reviews reported sex distribution of the included children and none reported the age distribution of included children.\nMedline was the most commonly searched database to help identify primary studies for inclusion in the reviews. The Cochrane library was the second most commonly searched database (Table 4). However, only about half of the reviews (51.1%) reported the years of coverage for the search. The same percentage of reviews reported the search terms used while only a minority (8.5%) of reports reproduced the entire search. Reviewing reference lists was the most commonly reported other search method used to identify potentially relevant primary studies (Table 4). About two thirds of the reviews (68.1%) reported including unpublished material when it existed and most reviews (78.7%) did not report having any primary study language restrictions.\nTable 4 Freqency of databases searched and other search methods used to identify primary studies included in systematic reviews of pediatric complementary and alternative medicine\nDatabases Searched N %\nMedline (or Index Medicus) 32 68.1%\nCochrane Library 17 36.2%\nEmbase (or Excerpta Medica) 13 27.7%\nPsycLit (or Psych. Abstracts) 13 27.7%\nCINAHL 10 21.3%\nDissertation Abstracts 7 14.9%\nBiosis (or Biological Abstracts) 6 12.8%\nScience Citation Index (ISI) 5 10.6%\nCurrent Contents 3 6.4%\nPysclnfo 3 6.4%\nHealthStar 2 4.3%\nSocioFile or Sociological Abstracts 2 4.3%\nOther Bibliographic Databases1 12 25.5%\nOther Trials Registries2 2 4.3%\nOther search methods\nReference Lists Reviewed 34 72.3%\nExperts / Corresponding Authors 16 34.0%\nHand Searching 11 23.4%\nConference Proceedings / Abstracts 8 17.0%\nPharmaceutical Companies / Manufacturers 6 12.8%\nNo search reported 4 8.5%\nPersonal Files 3 6.4%\nSearch mentioned but details not reported 3 6.4%\nSubject Bibliography 1 2.1%\n1Other databases searched included ALTA religions database, Cancelit, CISCOM, ERIC, Index to the Chiropractic Literature, MANTIS, Mental Health Abstracts, Phytodok and SIGLE 2Other trial registries searched included National Library of Medicine database of published trials and Oxford database of perinatal trials. The quality of reporting of all 47 PedCAM reviews is presented in Table 5. Authors were particularly good at reporting: eligibility criteria for including primary studies, combining the primary studies for quantitative analysis appropriately, and basing their conclusions on the data included in the review. Reviewers were weaker in reporting: how they avoided bias in the selection of primary studies, and how they evaluated the validity of the primary studies. Overall the scientific quality of the reports achieved 43% (median = 3) of their maximum possible total score (Table 5).\nTable 5 Quality of reports of complementary and alternative medicine systematic reviews and comparative conventional medicine systematic reviews\nMatched reviews\nQuestion Complementary and Alternative Medicine Reviews (n = 47) n (%) Complementary and Alternative Medicine Reviews (n = 17) n (%) Comparative Conventional Medicine Reviews (n = 19) n (%) p value\n1. Were the search method used to find evidence reported? 24 (51) 12 (71) 10 (53) 0.270\n2. Was the search for evidence reasonably comprehensive? 19 (40) 7(41) 6(32) 0.549\n3. Were the criteria for deciding which studies to include in the overview reported? 34 (72) 12 (71) 8(42) 0.086\n4. Was bias in the selection of studies avoided? 10 (21) 5(29) 5(26) 0.836\n5. Were the criteria used for assessing the validity of the included studies reported? 24 (51) 9(53) 5(26) 0.101\n6. Was the validity of all the studies referred to in the text assessed using appropriate criteria? 17 (36) 7(41) 6(32) 0.549\n7. Were the methods to combine the findings of the relevant studies reported? 21 (64)1 7 (70)4 6 (55)3 0.466\n8. Were the findings of the relevant studies combined appropriately relative to the primary question the overview addresses? 25 (81)2 8 (80)3 7 (64)3 0.407\n9. Were the conclusions made by the author(s) supported by the data and/or analysis reported in the overview? 36 (77) 12 (71) 6(33) 0.021\n10. How would you rate the scientific quality of this overview?4 3 (2, 4) 3 (2,4) 3 (2, 3.5) 0.752\n1 Percentage calculated after removing those systematic reviews that were not applicable (n=33).\n2 Percentage calculated after removing those systematic reviews that were not applicable (n=31).\n3 Percentage calculated after removing those systematic reviews that were not applicable (n=11).\n4 Median and 95% confidence intervals We were able to use 17 PedCAM systematic reviews along with 19 conventional therapy reviews (available from the authors upon request) and compare their quality (Table 5). The PedCAM reports were always assessed as higher quality for all nine items on the Oxman and Guyatt scale and this reached statistical significance for one item (Table 5). There was no difference in the overall scientific quality of either type of review with both types achieving 43% of their maximum possible score.\nApproximately a third of the reviews (38%) reported evaluating statistical heterogeneity. Less than a quarter of them (17%) reported assessing for the presence of publication bias. Information regarding adverse events was reported in less than a quarter of the reviews (14.9%). Similarly, information regarding costs (e.g., cost effectiveness) was only reported in one review. About half (55.3%) of the reviews reported the funding source for the systematic review."}