For reviews reporting a meta-analysis, we will collect the pooled effect estimates, corresponding confidence intervals, and results of statistical tests for heterogeneity e.
For network meta-analyses, ideally sufficient evidence from direct comparisons will be available, and treatment effect estimates along with measures of uncertainty from those analyses will be extracted.
However, where little to no evidence from direct comparisons is available and indirect comparison data exist, we will extract both analyses and determine extent of consistency of results and make appropriate interpretations.
For indirect comparison analyses, effect estimates and corresponding credible intervals will be collected from indirect comparisons. For example, if effect estimates from primary studies are reported, then a range of those effects could be extracted.
In the absence of optimal quantitative data, a narrative summary of findings will be extracted from the reviews. Data will be collected for all reported and relevant see Table 1 time points of follow-up.
Where reviews partially overlap with the scope of interest, such that a subset of studies may be conducted in a different population e. How these analyses are handled inclusion versus exclusion will be reviewed with the WG for their input; those decisions and any accompanying uncertainty in the applicability of the included results will be detailed in the report.
The overview will seek information on various factors that would typically be considered variables for effect modification.
In the case of an overview, we expect to encounter reviews that have undertaken subgroup or meta-regression analyses. There may also be reviews through the process of defining scope that would have focused their interest according to a particular factor, such as evaluating the effects of an intervention in a particular setting. Reviews addressing both of these approaches will be included. Variables of interest listed below are those that we have considered as being potentially important effect modifiers that would influence the development of guideline recommendations or implementation considerations.
According to guidance, we have restricted subgroup analysis to characteristics that are measured at baseline rather than after randomization [ 99 ]. Fewer versus more quit attempts specific groupings will depend on what is found in the literature. Baseline level of nicotine dependence e. By comorbid conditions e. While there are both simple e.
Bucher method, network meta-analysis methods available for indirect comparisons of treatments across reviews, all approaches are based on the assumption that the primary studies are similar [ 85 , ]. Given that we will not have opportunity to read and become familiar with the primary study reports themselves, conducting network meta-analyses or informal indirect comparisons of interventions will not be performed. As noted above, any existing network meta-analyses located in the literature will be included and commented on.
Similarly, subgroup analyses within reviews will provide evidence for effect modification. For factors that comprise the focused scope of a given review, as described in the previous section, we will provide the appropriate statements relating to interpretation but be unable to perform comparisons across reviews in the absence of the direct familiarity with the primary studies.
Where possible, we will evaluate the credibility of subgroup analyses [ 99 , , ]. Although a narrative synthesis of available evidence to ensure appropriate interpretation will be provided for readers, the use of GRADE tables will facilitate appropriate presentation of this information in tabular form to avoid juxtaposition that may lend to inappropriate comparisons on the part of the reader [ 83 , 85 , ].
Comparisons across reviews with similar scope will be limited to an assessment of the extent of concordance or discordance of the review results and, for discordance, an exploration of a potential explanation.
In those instances, we will investigate the source s of discordance using the algorithm developed by Jadad et al. Where overlapping reviews of similar quality rely on the exact same studies, we will investigate whether discordance was due to differences in data extraction e. If overlapping reviews do not rely on the exact same studies, we will investigate differences in the eligibility criteria. If similar, we will evaluate whether discordance is attributable to differences in the search strategies e.
If reviews use different eligibility criteria, Jadad et al. In addition to exploring sources of discordance, we will categorize discordance as follows: 1 direction of effect i.
The Task Force endorses the use of GRADE methodology for assessing the quality of the body of evidence for critical and important outcomes [ ]. Currently, there are no methods to evaluate the strength of evidence across systematic reviews [ 83 ]. We will not evaluate the strength of the evidence across reviews. For reviews that have used GRADE methods, we will provide results for the overall quality of evidence, including reasons for downgrading.
We will not consult primary studies as a quality control measure. This will likely be challenging due to reporting issues; therefore, we will provide our best interpretation based on the available information and note any limitations. For systematic reviews that include a network meta-analysis, using information reported in the review, we will evaluate the quality of evidence using the GRADE extension for network meta-analysis [ ]. The search strategy for this update will be developed using the search strategy of the candidate systematic review, once identified.
The search strategy of the candidate review will be evaluated and modified as necessary. Databases will be searched from the last search date of the review.
We will also search the Cochrane Library on Wiley. The grey literature will be searched using the same approach outlined for the overview of reviews. Studies will be selected for inclusion using the criteria outlined in Table 3. Study selection and data extraction will follow the same process described for the overview of reviews.
Where study eligibility is unclear, authors will be contacted by email twice over 2 weeks for additional information. We will collect both self-report and biochemically validated tobacco abstinence and relapse. Data will be collected for all reported and relevant see Table 3 time points of follow-up. Where needed, we will convert data e.
Authors will be contacted by email twice over 2 weeks if any information is missing or unclear. Refer to Additional file 6 for a list of draft items to be collected during data extraction. We will consult studies included in the original review to ensure that all outcomes of interest Table 3 have been captured. The risk of bias of randomized and non-randomized controlled trials will be assessed by one reviewer using the Cochrane risk of bias ROB tool [ ] Additional file 7.
A modified version of the Scottish Intercollegiate Guidelines Network critical appraisal tool [ ] Additional file 8 , which accounts for potential sources of bias including that arising from industry funding, will be used to evaluate the quality of prospective cohort studies. Verification will be done by a second reviewer. Disagreements will be resolved by consensus or third-party adjudication.
Some domains are outcome-specific and will be assessed at the outcome level. Overall risk of bias for the body of evidence will be evaluated according to the importance of domains, the likely direction of bias, and the likely magnitude of bias [ ]. The Agency for Healthcare Research and Quality guidance will be followed for evaluating risk of bias for outcome and analysis reporting bias [ ].
Study characteristics will be summarized narratively and presented in summary tables. Risk ratios and risk differences will be used to report effects for dichotomous data. For calculating the risk difference from meta-analyzed data, we will use the median baseline risk for the control group in the included studies, although we may perform sensitivity analysis using differing baseline risks if thought to be suitable.
For continuous outcomes, mean difference i. We will examine the extent of clinical and methodological heterogeneity to determine appropriateness of performing meta-analysis.
If appropriate, data from the original systematic review will be meta-analyzed with data from newly identified studies, using random effects models. For time-to-event data, the hazard ratio will be pooled using the generic inverse variance method.
Analyses will be stratified by study design. For observational studies, we will use adjusted risk estimates in the meta-analysis. Should meta-analysis not be appropriate due to considerable heterogeneity, the range of effects will be presented and results will be discussed narratively. Studies will also be presented in a forest plot without a pooled risk estimate. We will follow previously published guidance for meta-regression [ ].
Results will be synthesized narratively if studies report rare events. The risk difference will be used for outcomes e.
If there are sufficient data, the following subgroup analyses will be conducted:. Intensity of behavioural therapy groupings will depend on what is found in the literature. Duration of e-cigarette usage as part of the intervention groupings will depend on what is found in the literature.
Sensitivity analyses restricted to low risk of bias studies may be performed. Sensitivity analyses may also be performed to explore statistical heterogeneity or to evaluate the impact of various decisions made during the conduct of the review.
The Cochrane Review Manager software version 5. For critical and important outcomes, the GRADE framework [ , ] will be used to assess the quality of the evidence.
In response to this important public health care issue, the Canadian Task Force on Preventive Health Care will be developing a national tobacco smoking cessation guideline informed by an overview of systematic reviews of the benefits and harms of various stop smoking interventions for adults and relevant subpopulations, where available. This document has outlined the methods for undertaking the overview and an update of e-cigarette evidence for that overview.
Draft data extraction items for the updated review of e-cigarettes for smoking cessation. DOCX 12 kb. The authors also acknowledge Marion Doull and Rachel Rodin from the Public Health Agency of Canada for their input and direction during project scoping and refinement. Funding for this protocol and subsequent evidence review is provided by the Public Health Agency of Canada. This funding will support all phases of conduct of the evidence review, including the search and selection of the evidence, collection of the data, data management, analyses, and writing.
The funder was involved in the development of the protocol and will give approval to the final version. For the conduct of the review, the funder will also be given opportunity to comment, but final decisions will be made by the review team. In addition, the funder will not be involved in study selection, data extraction, or analysis.
BS developed the search strategy and provided text for the protocol. MM provided a patient perspective for the protocol. All authors read and approved the final manuscript. Written informed consent to publish was obtained from the stakeholders who provided feedback on the protocol.
A copy of the written consent is available for review by the Editors-in-Chief of this journal. The stakeholder feedback has been anonymized and included as Additional file 9. BH has received consultancy fees from Cornerstone Research Group for methodologic advice related to systematic reviews and meta-analysis and is a member of the Editorial team for Systematic Reviews.
PS reports grants and research support from Pfizer Inc. The remaining authors declare that they have no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Mona Hersi, Email: ac.
Gregory Traversy, Email: ac. Brett D. Thombs, Email: ac. Andrew Beck, Email: ac. Becky Skidmore, Email: moc. Eddy Lang, Email: ac. Donna L. Reynolds, Email: ac. Brenda Wilson, Email: ac. Steven L. Bernstein, Email: ude. Peter Selby, Email: ac. Stephanie Johnson-Obaseki, Email: moc. Douglas Manuel, Email: ac. Smita Pakhale, Email: ac. Justin Presseau, Email: ac. Susan Courage, Email: ac.
Brian Hutton, Email: ac. Beverley J. Shea, Email: ac. Vivian Welch, Email: gro. Matt Morrow, Email: moc. Julian Little, Email: ac. Adrienne Stevens, Email: ac. National Center for Biotechnology Information , U. Journal List Syst Rev v. Syst Rev. Published online Jan Reynolds , 9, 10 Brenda Wilson , 11 Steven L. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Aug 29; Accepted Dec This article has been cited by other articles in PMC.
DOCX 18 kb. Additional file 2: Search strategy for the overview of reviews. DOCX 16 kb. DOCX 77 kb. DOCX 14 kb. Additional file 5: Draft data extraction items for the overview of reviews. DOCX 13 kb. Additional file 6: Draft data extraction items for the updated review of e-cigarettes for smoking cessation. Additional file 7: Cochrane risk of bias tool.
DOCX 29 kb. DOCX 26 kb. Additional file 9: Stakeholder feedback. DOCX 34 kb. Abstract Background Tobacco smoking is the leading cause of cancer, preventable death, and disability. Methods The evidence review will consist of two stages. Discussion The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults. Electronic supplementary material The online version of this article Stop smoking interventions Approved pharmacotherapies Nicotine replacement therapy NRT and cytisine are available over-the-counter while varenicline and bupropion are available by prescription [ 32 ].
Electronic cigarettes Electronic cigarettes, also known as e-cigarettes, electronic nicotine or non-nicotine delivery systems, or vaporizers, represent another potential intervention strategy by which individuals employ behaviour substitution in their efforts to quit smoking. Behavioural therapies There are various behavioural interventions used for tobacco cessation. Exercise Some therapies, such as exercise-based interventions, have been used alone or as adjuncts to other interventions.
Alternative therapies Alternative therapies for smoking cessation include hypnosis, acupuncture including acupressure and electrostimulation , and laser therapy [ 59 , 61 ]. Objective and key questions The goal of this evidence review is to determine the effectiveness of stop smoking strategies for adults. Stage 1: Overview of systematic reviews of stop smoking interventions The overview will evaluate the benefits and harms of stop smoking interventions among adults.
Open in a separate window. Stage 2: Updated systematic review on e-cigarette use for smoking cessation This update will evaluate the benefit and harms of e-cigarettes to promote cessation of tobacco smoking among adults. Stage 1: Overview of systematic reviews of stop smoking interventions Guidelines for the conduct of overviews of reviews are currently lacking [ 79 ]. Literature search The search strategy will be developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team.
Eligibility criteria KQ1a and KQ1b will examine interventions that can be delivered or referred to in the primary care setting.
Table 1 Inclusion and exclusion criteria for key question 1a and 1b. The overview of reviews will seek information on the effects of variations in the delivery of stop smoking interventions e. Nicobrevin, Nicobloc, nicotine vaccines, mecamylamine Broader public health interventions e. It was also decided that this outcome is most important for KQ1b h Although initially rated as being of limited importance by the WG, based on discussions with WG members, it was decided that this outcome should be considered as important.
Clinical experts and patients rated this outcome as important i Reviews will be considered systematic if they meet the four following criteria: 1 searches at least one database, 2 reports their selection criteria, 3 conducts quality or risk of bias assessment on included studies, and 4 provides a list and synthesis of included studies j Overviews will included if they meet the following criteria: 1 search at least one database, 2 report their selection criteria and how they will handle the inclusion of overlapping reviews, 3 provide information on the quality or risk of bias assessment of studies included in reviews, 4 provide a list of relevant reviews, 5 report the synthesized evidence from the included reviews, and 6 explicit declaration that the decision to undertake the network meta-analysis was made with firsthand knowledge of the primary studies, to ensure appropriateness of the analysis.
Table 2 Inclusion and exclusion criteria for Key Question 1c. We will seek information on intervention characteristics which may moderate the effectiveness of behavioural change techniques e. Clinical experts and patients rated this outcome as important e Reviews will be considered systematic if they meet the four following criteria: 1 searches at least one database, 2 reports their selection criteria, 3 conducts quality or risk of bias assessment on included studies, and 4 provides a list and synthesis of included studies 6 Overviews will included if they meet the following criteria: 1 search at least one database, 2 report their selection criteria and how they will handle the inclusion of overlapping reviews, 3 provide information on the quality or risk of bias assessment of studies included in reviews, 4 provide a list of relevant reviews, 5 report the synthesized evidence from the included reviews, and 6 explicit declaration that the decision to undertake the network meta-analysis was made with firsthand knowledge of the primary studies, to ensure appropriateness of the analysis.
Study selection Duplicates will be identified and removed using Reference Manager [ 91 ]. Data mapping and overlap detection Given the proliferation of systematic reviews [ 81 ], we anticipate that we will encounter multiple systematic reviews covering the same research question i.
Quality assessment of systematic reviews The methodological quality of reviews will be evaluated according to the AMSTAR 2 instrument Additional file 3. Data extraction and management Data extraction forms will be developed a priori in DistillerSR and pilot tested on a sample of studies to adjust forms, where needed, to maximize efficiency.
Subgroup analysis The overview will seek information on various factors that would typically be considered variables for effect modification. Populations Fewer versus more quit attempts specific groupings will depend on what is found in the literature Opportunistic versus individuals seeking treatment Baseline level of nicotine dependence e. Evidence synthesis While there are both simple e.
Quality of the body of evidence The Task Force endorses the use of GRADE methodology for assessing the quality of the body of evidence for critical and important outcomes [ ]. Stage 2: Updated systematic review on electronic cigarettes for smoking cessation Literature search The search strategy for this update will be developed using the search strategy of the candidate systematic review, once identified.
Eligibility criteria Studies will be selected for inclusion using the criteria outlined in Table 3. Table 3 Inclusion and exclusion criteria for an updated review on e-cigarettes. It was also decided that this outcome is most important for KQ1b c Although initially rated as being of limited importance by the WG, based on discussions with WG members, it was decided that this outcome should be considered as important.
Study selection and data extraction Study selection and data extraction will follow the same process described for the overview of reviews. Refer to Additional file 6 for a list of draft items to be collected during data extraction We will consult studies included in the original review to ensure that all outcomes of interest Table 3 have been captured. Analysis Study characteristics will be summarized narratively and presented in summary tables. Meta-analysis We will examine the extent of clinical and methodological heterogeneity to determine appropriateness of performing meta-analysis.
Sparse binary data and studies with zero events Results will be synthesized narratively if studies report rare events. Subgroup analysis If there are sufficient data, the following subgroup analyses will be conducted: Fewer versus more quit attempts specific groupings will depend on what is found in the literature Opportunistic versus individuals seeking treatment Baseline level of nicotine dependence e.
Sensitivity analysis Sensitivity analyses restricted to low risk of bias studies may be performed. Software The Cochrane Review Manager software version 5. Grading the quality of evidence and interpretation For critical and important outcomes, the GRADE framework [ , ] will be used to assess the quality of the evidence.
Although Chantix did, cause reduced fetal weight in the offspring of pregnant rabbits. Chantix varenicline also reduces the satisfaction a smoker receives when smoking a cigarette. Antonio Howell. Here are 6 facts you should know about laser treatment to stop smoking: There is less evidence suggesting that laser treatment to stop smoking is effective. However, studies conducted to assess this form of smoking cessation method show that majority of smokers who used it were able to successfully quit.
This treatment involves lower levels of laser also called cold laser therapy and it works like acupuncture, only that the modern technology laser is used instead of needles. It targets areas in the body that cause the release of endorphins — the natural chemicals which have mood-enhancing, relaxing and calming effects. Some smokers who tried this treatment report experiencing feelings of euphoria. This effect eases the withdrawal symptoms felt by the smoker.
Laser therapy is considered safe and effective. Generally, one session just takes 37 minutes. The smoker may need several sessions to quit smoking successfully, depending on their level of nicotine dependence and some other factors. Sometimes, it just takes a single session to eliminate the habit. Skip to content. PRICING The total stop smoking package, which includes the drug-free pain-free laser therapy, detox program, guidance and counselling, and continued 24 hr. BENEFITS Your risk of developing lung cancer, other cancers, heart attack, stroke, and chronic lung disease is reduced the sooner you stop smoking, the sooner your risk starts going down.
Quitting Smoking at any age increases your life expectancy if you stop before the onset of serious disease. Even if you have developed a disease, you can benefit from stopping as your body will be under less strain and can fight it more easily. A smoker who has suffered from a heart attack can halve the risk of a second heart attack by quitting smoking. Smokers who stop before the age of 35 have a life expectancy not significantly different from that of a non-smoker. Smokers who give up smoking between 65 and 74 years of age have a better life expectancy beyond 75 than those who continue to smoke.
Your energy levels will soon soar when you quit smoking, making it easier to run for the bus or play sports with your friends. Rediscover the taste of your favorite foods as your taste buds kick back in after you give up smoking. Each cigarette takes about 10 minutes to smoke, so a a-day smoker can save nearly 2 hours a day when they quit.
Over the course of a year, you can claim back a month of lost time! Smokers are shocked to find how quickly they get hooked on smoking.
Stopping is a real achievement and can give you a real boost in confidence and self-esteem.
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