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Use of traditional Chinese medicine for the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients: An evidence mapping study
Background: The potential effectiveness of traditional Chinese medicine (TCM) against "epidemic diseases " has highlighted the knowledge gaps associated with TCM in COVID-19 management. This study aimed to map the matrix for rigorously assessing, organizing, and presenting evidence relevant to TCM in COVID-19 management.Methods: In this study, we used the methodology of evidence mapping (EM). Nine electronic databases, the WHO International Clinical Trials Registry Platform (ICTRP) Search Portal, , gray literature, reference lists of articles, and relevant Chinese conference proceedings, were searched for articles published until 23 March 2022. The EndNote X9, Rayyan, EPPI, and R software were used for data entry and management.Results: In all, 126 studies, including 76 randomized controlled trials (RCTs) and 50 systematic reviews (SRs), met our inclusion criteria. Of these, only nine studies (7.14%) were designated as high quality: four RCTs were assessed as "low risk of bias " and five SRs as "high quality. " Based on the research objectives of these studies, the included studies were classified into treatment (53 RCTs and 50 SRs, 81.75%), rehabilitation (20 RCTs, 15.87%), and prevention (3 RCTs, 2.38%) groups. A total of 76 RCTs included 59 intervention categories and 57 efficacy outcomes. All relevant trials consistently demonstrated that TCM significantly improved 22 outcomes (i.e., consistent positive outcomes) without significantly affecting four (i.e., consistent negative outcomes). Further, 50 SRs included nine intervention categories and 27 efficacy outcomes, two of which reported consistent positive outcomes and two reported consistent negative outcomes. Moreover, 45 RCTs and 38 SRs investigated adverse events; 39 RCTs and 30 SRs showed no serious adverse events or significant differences between groups.Conclusion: This study provides evidence matrix mapping of TCM against COVID-19, demonstrating the potential efficacy and safety of TCM in the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients, and also addresses evidence gaps. Given the limited number and poor quality of available studies and potential concerns regarding the applicability of the current clinical evaluation standards to TCM, the effect of specific interventions on individual outcomes needs further evaluation.
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Wearing masks to reduce the spread of respiratory viruses: a systematic evidence mapping
Since the outbreak of coronavirus disease in 2019, the controversy over the effectiveness, safety, and enforceability of masks used by the public has been prominent. This study aims to identify, describe, and organize the currently available high-quality design evidence concerning mask use during the spread of respiratory viruses and find evidence gaps. Databases including PubMed, Cochrane Library, Web of Science, EMBASE, WHO International Clinical Trials Registry Platform (ICTRP), clinical trial registry, gray literature database, and reference lists of articles were searched for relevant randomized controlled trials (RCTs) and systematic reviews (SRs) in April 2020. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. A bubble plot was designed to display information in four dimensions. Finally, twenty-one RCTs and nine SRs met our inclusion criteria. Most studies were of "Low quality" and focused on healthcare workers. Six RCTs reported adverse effects, with one implying that the cloth masks reuse may increase the infection risk. When comparing masks with usual practice, over 70% RCTs and also SRs showed that masks were "beneficial" or "probably beneficial"; however, when comparing N95 respirators with medical masks, 75% of SRs showed "no effect", whereas 50% of RCTs showed "beneficial effect". Overall, the current evidence provided by high-quality designs may be insufficient to deal with a second impact of the pandemic. Masks may be effective in interrupting or reducing the spread of respiratory viruses; however, the effect of an N95 respirator or cloth masks versus medical masks is unclear. Additional high-quality studies determining the impact of prolonged mask use on vulnerable populations (such as children and pregnant women), the possible adverse effects (such as skin allergies and shortness of breath) and optimal settings and exposure circumstances for populations to use masks are needed.
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