AMSTAR-R is not a specific tool for evaluating systematic reviews of patient-reported outcome measures, however, no alternative instrument was found to perform the risk of bias analysis. AMSTAR had two

The gap

Consensus across the literature

Supporting evidence — 3 representative gaps

• PFO closure in ischemic stroke: insights from a single-center real-world cohort (2026) · doi

  Important limitations merit acknowledgment. The single-center design limits generalizability, although our institution serves a large catchment area with diverse patient demographics. The inclusion of both retrospectively identified (n = 142) and prospectively enrolled patients (n = 46) introduces the risk of heterogeneous data quality and ascertainment bias. A descriptive comparison of key baseline parameters between the two subgroups suggested that prospectively enrolled patients more frequently underwent PFO closure and had PFO more often attributed as the cause of the index event, likely reflecting improvements in diagnostic workup and interdisciplinary decision-making over the course of the study period rather than a systematic bias. Nevertheless, residual confounding from differential documentation practices cannot be fully excluded. The loss of 27 patients (12.5% of the original cohort of 215) due to withdrawal of consent or loss to follow-up represents a relevant limitation. A descriptive analysis of available parameters in excluded patients revealed that all 27 were identified retro- spectively, showed a lower rate of PFO closure, and had less

  Keywords: patients identified prospectively enrolled bias descriptive parameters closure excluded loss important limitations merit acknowledgment single
• Quality assessment of the satisfaction degree in anesthesia: overview of systematic reviews (2026) · doi

  AMSTAR-R is not a specific tool for evaluating systematic reviews of patient-reported outcome measures, however, no alternative instrument was found to perform the risk of bias analysis. AMSTAR had two items missing from the analysis, but the items refer to statistical analysis and it was expected by the authors of this review that these types of systematic reviews would not perform meta-analysis. The deletion of two items may have altered the validation of the instrument, however we included a brief description of all instruments indicated by the reviews so that the reader can make their own judgment without considering the analysis of the systematic reviews included.

  Keywords: reviews systematic items amstar instrument perform included speci tool evaluating patient reported outcome measures alternative
• Exploring the role of racial/ethnic patient–physician concordance in optimizing health and patient outcomes among black populations in the United States: an integrative systematic review (2026) · doi

  This review has several limitations. First, although the revised search strategy included both PubMed and Web of Science, relevant studies indexed in other databases such as Embase, Scopus, CINAHL, PsycINFO, or Sociological Abstracts may not have been captured. Second, the search was limited to studies published from 2015 to 2026, which emphasized contemporary literature but may have excluded older foundational studies. the Third, included literature was methodologically heterogeneous. Studies varied in design, population, clinical setting, exposure definition, and outcome measurement, which precluded meta-analysis. Most primary empirical studies were observational, cross-sectional, or survey-based, limiting causal inference. Several relied on patient-reported outcomes, which are highly relevant to patient experience but may be influenced by unmeasured contextual factors. Fourth, a formal risk-of-bias assessment and GRADE certainty evaluation were not performed. Instead, evidence was interpreted narratively with attention to design limitations, consistency, directness, and relevance. Fifth, some included studies examined concordance indirectly through related constructs such as implicit bias, patient preference, therapeutic connection, or workforce representation. These studies were useful for conceptual synthesis but should not be interpreted as direct tests of concordance effects. Finally, very few included studies differentiated among Black subgroups. As a result, subgroup-specific inference for Foundational Black Americans, African immigrants, and Afro- Caribbean immigrants remains limited. Future research should incorporate more precise subgroup measures where appropriate and avoid treating Black populations as analytically homogeneous. populations. communication training, reducing implicit bias, and expanding culturally responsive care may work together to improve healthcare experiences for Black patients and other underserved populations. Future research should use more rigorous designs, clearer outcome definitions, and more refined subgroup characterization within Black should examine whether concordance-related effects differ by nativity, migration history, lineage, or other markers of within-group heterogeneity. This would allow future work to better determine and workforce how concordance, representation can be implemented in ways that are evidence- based, patient-centered, and responsive to the diversity of Black populations in the United States. responsiveness, In particular, cultural studies

  Keywords: black included patient concordance populations bias subgroup future several limitations search relevant limited literature foundational