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Comprehensive Systematic Review Training Program Module 1 Comprehensive Systematic Review Training Program Module 1: Workbook Introduction to Evidence-based Healthcare and the Systematic Review of Evidence www.joannabriggs.org Comprehensive Systematic Review Training Program Module 1: Workbook Introduction to Evidence-based Healthcare and the Systematic Review of Evidence JBI/CSRTP/2017/0001 Published by The Joanna Briggs Institute. Adelaide, South Australia, Australia. © The Joanna Briggs Institute 2017 This Publication is copyright. Apart from any fair dealing for the purpose of private study, research, criticism or review as permitted under the Copyright Act, no part may be reproduced by any process or placed in computer memory without written permission. All inquiries should be made to the Joanna Briggs Institute. Introduction to Evidence-based Healthcare and the Systematic Review of Evidence - Module 1 – Workbook 2 Contents Activity 1: Example Systematic Reviews 4 Ravindran and Silva 2013 . 5. Elliott et al 2015 . 18 Activity 2: Question and Inclusion Criteria Development 27 Activity 3: Logging into JBI SUMARI 31 Activity 4: Logic Grid Development 32 Activity 5: Uploading Search Results into JBI SUMARI 34 Activity 6: Selecting Studies 35 Vernaya and McAdam 2015 . 36. Activity 7: Developing a protocol in JBI SUMARI 56 Introduction to Evidence-based Healthcare and the Systematic Review of Evidence - Module 1 – Workbook 3 Activity 1: Example Systematic Reviews Scan over the two example papers that claim to be systematic reviews by Ravindran and Silva 2013 and Elliott et al 2015 provided in the subsequent pages of this workbook with a particular focus on the methods and results section. Answer the following questions: a) Are both papers examples of systematic reviews? Explain your reasoning. b) Would you consider both examples to be of good quality? Explain your reasoning. Introduction to Evidence-based Healthcare and the Systematic Review of Evidence - Module 1 – Workbook 4 Journal of Affective Disorders 150 (2013) 707–719 Contents lists available at ScienceDirect Journal of Affective Disorders journal homepage: www.elsevier.com/locate/jad Review Complementary and alternative therapies as add-on to pharmacotherapy for mood and anxiety disorders: A systematic review Arun V. Ravindran a,b,n, Tricia L. da Silva b,c a Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada M5T 1R8 b Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, Ontario, Canada M6J 1H4 c Institute of Medical Science, University of Toronto, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada M5S 1A8 article info abstract Article history: Background: Depressed and anxious patients often combine complementary and alternative medicine Received 22 January 2013 (CAM) therapies with conventional pharmacotherapy to self-treat symptoms. The benefits and risks of Received in revised form such combination strategies have not been fully evaluated. This paper evaluates the risk-benefit profile of 22 March 2013 CAM augmentation to antidepressants in affective conditions. Accepted 17 May 2013 Methods: PubMed was searched for all available clinical reports published in English up to December Available online 12 June 2013 2012. Data were evaluated based on graded levels of evidence for efficacy and safety. Keywords: Results: Generally, the evidence base is significantly larger for depression than for anxiety disorder. Anxiety disorders In unipolar depression, there is Level 2 evidence for adjunctive sleep deprivation (SD) and Free and Augmentation Easy Wanderer Plus (FEWP), and Level 3 for exercise, yoga, light therapy (LT), omega-3 fatty acids, Combination S-adenosylmethionine and tryptophan. In bipolar depression, there is Level 1 evidence for adjunctive Complementary and alternative medicine Depressive disorders omega-3s, Level 2 for SD, and Level 3 for LT and FEWP. In anxiety conditions, exercise augmentation has Systematic review Level 3 support in generalized anxiety disorder and panic disorder. Though mostly well-tolerated, these therapies can only be recommended as third-line interventions due to the quality of available evidence. Limitations: Overall, the literature is limited. Studies often had methodological weaknesses, with little information on long-term use and on potential drug–CAM interactions. Many CAM studies were not published in English. Conclusions: While several CAM therapies show some evidence of benefit as augmentation in depressive disorders, such evidence is largely lacking in anxiety disorders. The general dearth of adequate safety and tolerability data encourages caution in clinical use. & 2013 Elsevier B.V. All rights reserved. Contents 1. Introduction........................................................................................................708 1.1. Caveat....................................................................................................... 708 2. Methods...........................................................................................................708 3. Resultsanddiscussion................................................................................................708 3.1. Physicaltherapies............................................................................................. 708 3.1.1. Exercise..............................................................................................710 3.1.2. Yoga.................................................................................................711 3.1.3. Lighttherapy(LT)......................................................................................711 3.1.4. Sleepdeprivation(SD)...................................................................................712 3.1.5. Acupuncture...........................................................................................712 3.2. Herbalremedies............................................................................................... 713 3.2.1. FreeandEasyWandererPlus(FEWP).......................................................................713 3.3. Nutraceuticals................................................................................................ 713 3.3.1. Omega-3fattyacids.....................................................................................713 3.3.2. S-adenosylmethionine(SAM-e)............................................................................713 3.3.3. Dehydroepiandrosterone(DHEA)..........................................................................714 3.3.4. Tryptophan............................................................................................714 n Corresponding author. Tel.: +1 416 979 6933; fax: +1 416 260 4171. E-mail address: [email protected] (A.V. Ravindran). 0165-0327/$ - see front matter & 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.jad.2013.05.042 Ravindran and Silva 2013 Introduction to Evidence-based Healthcare and the Systematic Review of Evidence - Module 1 – Workbook 5 708 A.V. Ravindran, T.L. da Silva / Journal of Affective Disorders 150 (2013) 707–719 3.3.5. Folate................................................................................................714 3.3.6. Inositol...............................................................................................714 3.3.7. N-acetylcysteine(NAC)..................................................................................715 4. Conclusionsandfuturedirections...................................................................................... 715 Roleoffundingsource................................................................................................... 715 Conflictofinterest....................................................................................................... 715 Acknowledgments....................................................................................................... 715 References............................................................................................................. 715 1. Introduction herbal remedies and nutraceuticals as augmentation to medication in mood and anxiety disorders and published in English up to Epidemiological studies have consistently shown that depres- December 2012. The disorders covered in this review include: sive and anxiety disorders are among the most common mental major depressive disorder (MDD), dysthymia, psychotic depres- illnesses. The 1-year prevalence of depressive illness ranges from sion, treatment resistant depression (TRD), chronic depression, 4% to 11% worldwide, while that of anxiety disorders is 3% to 18% bipolar disorder, seasonal affective disorder, generalized anxiety globally (Alonso, 2007; WHO, 2000). disorder (GAD), panic disorder (PD), obsessive-compulsive disor- fi Though pharmacotherapy is generally the rst line of treat- der (OCD), social anxiety disorder (SAD) and post-traumatic stress ment for depression and anxiety, it has limitations. Many patients disorder (PTSD). Study results were evaluated using the standard continue to be symptomatic despite adequate treatment, and in criteria for considering the strength of evidence for efficacy and spite of several antidepressant trials, including combinations of tolerability (see Table 1). Data from randomized, controlled trials drugs (Rush et al., 2004; Yonkers et al., 2003). Their side effects (RCTs) and meta-analyses for the CAMs that showed the strongest and the high costs associated with medication use
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