Methodological Appraisal Research Articles

Siblings of Persons with Disabilities: A Systematic Integrative Review of the Empirical Literature.

The systematic review aimed to systematize the empirical literature on the psychological impact of disability on the siblings of persons with disabilities, to inform research and provide clinical recommendations. Two research questions addressed the review: (1) What are the main psychological constructs investigated in siblings of persons with disability? (2) What is the main role of each psychological construct in siblings of persons with disability experience? The electronic search was conducted in 7 databases and the PRISMA diagram was used. The inclusion criteria were: Papers published in English and in peer-reviewed journals; papers published between January 2014 and June 2024; qualitative, quantitative, and mixed studies; and papers on the psychological impact of disabilities and/or chronic illnesses on the experience of siblings of persons with disabilities. The standardized Mixed Method Appraisal Tool protocol was used to appraise the methodological quality of the studies. To summarize the findings, a narrative approach was adopted. A total of 60 studies have been reviewed. According to the methodological quality appraisal of studies, most of them reported a high (n = 45) and medium (n = 15) quality. They involved 10,146 participants. Findings revealed that sibling relationships, sibling-focused parentification, and emotional/behavioral adjustment are the main psychological constructs investigated by existing literature. Few studies focused on siblings' well-being. Studies exploring more than a psychological construct were included as a hybrid. Only one study examined the siblings' psychological experience during the COVID-19 pandemic. The quality of the sibling relationship ranged from good to poor; the caregiver is the main role played by siblings of persons with disabilities; anxiety, depression, and aggressive behaviors are the main emotional/behavioral symptoms revealed. Most studies (n = 39) recruited participants with brothers or sisters with mental disorders. The findings of this systematic review may play a role in the clinical field, as they might help to design gender- and age-specific intervention programs.

Antitumour activity of oleanolic acid: A systematic review and meta‑analysis.

Oleanolic acid (OA), a compound known for its potent antitumour properties, has been the subject of investigations in both cell and animal models. Although OA has good biological activity, its low water solubility and bioavailability limit its therapeutic use, and therefore translating the potential of OA into the clinical oncology setting remains challenging. The present systematic review and meta-analysis utilized evidence from animal model studies to gain insights into the antitumour mechanisms of OA to address the gap in understanding, and to provide guidance for future research directions and potential clinical applications. The guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were applied in the present study and a comprehensive search was conducted across the PubMed/MEDLINE, Web of Science, Cochrane Library and Embase databases, with a cut-off date of June 30, 2023. The primary focus was on randomized controlled trials that used animal models to assess the antitumour effects of OA. The methodological quality appraisal was conducted using the Systematic Review Centre for Laboratory Animal Experimentation risk of bias tool, and tumour volume and weight served as the principal outcome measures. Data were analysed using the RevMan (version 5.3) and Stata SE11 software packages, with an assessment of heterogeneity conducted using the I2 statistical test, sensitivity analysis conducted using the leave-one-out approach, and evaluation of publication bias performed using Egger's test and funnel plot analysis. The present study demonstrated a significant inhibitory effect of OA intervention on tumour growth and a decrease in tumour weight in animal models. Despite the broad spectrum of antitumour effects exhibited by OA, further investigations are warranted to optimize the dosage and administration routes of OA to maximize its efficacy in clinical cancer treatment.

A scoping review of undergraduate anatomy and physiology education: approaches to evaluating student outcomes in the United States.

Studies document difficulties undergraduate pre-nursing and allied health students face when learning human anatomy and physiology (A&P) course content. A comprehensive synthesis exploring the teaching practices within the course and how those practices are evaluated is warranted. This scoping literature review identified 78 journal articles investigating teaching practices, and we charted their research methods, student outcomes, and institutional contexts. Content analysis found the teaching practices described most frequently in A&P education research literature involved multiple aligned changes across the curriculum, including student activities, course delivery, and assessments. Critical appraisal of study methodologies revealed that most studies in undergraduate A&P were longitudinal, included comparison groups, and used simple inferential statistics. In contrast, few studies listed limitations of their research, collected data from multiple institutions, or reported student demographic data. We believe these factors pose notable limitations to the interpretation of A&P education studies across institutional contexts. The results of this review identify future lines of inquiry to enrich existing evidence about pedagogical interventions in A&P courses.

Methodological components, structure and quality assessment tools for evidence summaries: a scoping review.

The objective of this review was to identify and map the available information related to the definition, structure, and core methodological components of evidence summaries, as well as to identify any indicators of quality. Evidence summaries offer a practical solution to overcoming some of the barriers present in evidence-based health care, such as lack of access to evidence at the point of care, and the knowledge and expertise to evaluate the quality and translate the evidence into clinical decision-making. However, lack of transparency in reporting and inconsistencies in the methodology of evidence summary development have previously been cited and pose problems for end-users (eg, clinicians, policymakers). Any English-language resource that described the methodological development or appraisal of an evidence summary was included. PubMed, Embase, and CINAHL (EBSCOhost) were systematically searched in November 2019, with no limits on the search. The search was updated in June 2021 and January 2023. Gray literature searches and pearling of references of included sources were also conducted at the same time as the database searches. All resources (ie, articles, papers, books, dissertations, reports, and websites) were eligible for inclusion in the review if they evaluated or described the development or appraisal of an evidence summary methodology within a point-of-care context and were published in English. Literature reviews (eg, systematic reviews, rapid reviews), including summaries of evidence on interventions or health care activities that either measure effects, a phenomena of interest, or where the objective was the development, description or evaluation of methods without a clear point-of-care target, were excluded from the review. A total of 76 resources (n=56 articles from databases and n=20 reports from gray literature sources) were included in the review. The most common type/name included critically appraised topic (n=18) and evidence summary (n=17). A total of 25 resources provided a definition of an evidence summary: commonalities included a clinical question; a structured, systematic literature search; a description of literature selection; and appraisal of evidence. Of these 25, 16 included descriptors such as brief, concise, rapid, short, succinct and snapshot. The reported methodological components closely reflected the definition results, with the most reported methodological components being a systematic, multi-database search, and critical appraisal. Evidence summary examples were mostly presented as narrative summaries and usually included a reference list, background or clinical context, and recommendations or implications for practice or policy. Four quality assessment tools and a systematic review of tools were included. The findings of this study highlight the wide variability in the definition, language, methodological components and structure used for point-of-care resources that met our definition of an evidence summary. This scoping review is one of the first steps aimed at improving the credibility and transparency of evidence summaries in evidence-based health care, with further research required to standardize the definitions and methodologies associated with point-of-care resources and accepted tools for quality assessment. A Chinese-language version of the abstract of this review is available at http://links.lww.com/SRX/A59, studies ineligible following full-text review http://links.lww.com/SRX/A60.

Identifying High-Quality Non-Instrumental Dysphagia Screening Tools for Detection of Adult Dysphagia Case in Acute-Care Settings: A Systematic Review.

As patients nowadays tend to have multiple diseases and complex medical histories, our aim was to identify high-quality, non-instrumental dysphagia screening tools used for the detection of adult dysphagia cases in all disease categories in acute-care settings. A literature search was conducted in five databases from each database's earliest inception to 31 July 2021 and guided by five keywords: 'dysphagia', 'deglutition', 'screening', 'test' and 'measure'. Without limiting the search in any specific disease category, reviewers assessed original studies and identified tools if they had been validated against instrumental evaluations and if they had been designed as a pass-fail procedure to screen whether dysphagia is absent or present. We further excluded any tool if it was (1) for pediatric focus, or (2) a patient self-report questionnaire. All final tool candidates underwent a methodological quality appraisal using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Out of 195 studies with 165 tools identified, 20 tool candidates underwent QUADAS-2 review. We found six high-quality, non-instrumental screening tools for detecting adult dysphagia cases in acute-care settings, including the Yale Swallow Protocol, Gugging Swallowing Screen, Toronto Bedside Swallowing Screening Test (both English and Portuguese versions), Sapienza Global Bedside Evaluation of Swallowing and Two-Step Thickened Water Test. These high-quality tools were developed primarily for patients with stroke. Only Yale Swallow Protocol was originally tested for heterogeneous populations with stroke, multiple sclerosis, traumatic brain injury, oesophageal surgery, neurosurgery and head-and-neck cancer. The results highlight the gap in the unavailability of high-quality dysphagia screening tool in several emerged high-risk populations including elderly inpatients, or patients following endotracheal extubation. Further research is needed to determine whether these six tools can be effectively applied across different high-risk populations in acute-care settings to screen for cases finding.

Utility of a collaborative hematology oncology (HO) podcast series for post-ASCO updates and teaching critical appraisal.

9024 Background: Exploring strategies to share pivotal abstracts from the ASCO Annual Meeting is challenged by a paucity of resources focused on the critical appraisal of these abstracts. Podcasts are a valuable tool in medical education, though little is known on their utility to distribute post-ASCO updates compared to traditional formats (TF) including ASCO electronic updates, newsletters, Twitter, and emails. We sought to assess if a collaborative podcast series between two popular HO podcasts could enhance listeners’ self-perceived comprehension of conference material and improve knowledge in critical appraisal of research methodologies and statistical analysis. Methods: Five abstracts in 5 HO subspecialties (GI, hematology, lung, breast, and GU) presented at ASCO 2023 were selected by the co-authors. Abstracts were selected for high clinical impact and important critical appraisal teaching points. One podcast episode (PE) for each abstract (PROSPECT, SWOG 1826, CONTACT 003, KEYNOTE 671, NATALEE) was developed collaboratively between Two Onc Docs (TOD) and The Fellow on Call (TFOC) to provide background, results, limitations, and a concept in critical appraisal. Episodes were publicly available in July 2023. Between August-September 2023, a REDCAP survey was sent via Twitter to evaluate the efficacy of the PEs in breaking down abstracts and teaching critical appraisal. The survey utilized a 5-point Likert scale (1, “not at all” to 5, “entirely”). Descriptive statistics are presented. Results: A total of 58 individuals participated, including 33 fellows (57%), 7 attending physicians (12%), 6 APPs (10%), 5 residents (9%), 5 pharmacists (9%), and 2 others (3%). Most respondents (57%) did not attend ASCO 2023 while 36% attended in-person and 7% virtually. Prior to listening, there were 15 (26%) who reviewed 0 abstracts, 25 (43%) who reviewed 1-5, and 18 (31%) who reviewed ≥5. At baseline, 31% listened to TOD, 39% listened to TFOC, and 29% listened to both. Prior to the PEs, 43 respondents (74%) reviewed ≤ 2 of the selected abstracts and 7 (12%) reviewed all 5 abstracts. After the PEs release, 41 (71%) listened to ≥ 4 PEs, with 31 individuals (54%) listening to all 5. On a scale of 1-5, the mean response for the utility of the PEs in breaking down abstracts and teaching critical appraisal were 4.76 (SD 0.47) and 4.55 (SD 0.60) respectively. The majority (88%) felt the PEs were more helpful than TFs; 12% felt PEs were equally helpful. A total of 55 (95%) reported they would listen to future collaborative series for post conference information. Conclusions: In this analysis, we highlight listeners’ preference for podcasts over TF to improve comprehension and critical appraisal skills of abstracts presented at the ASCO Annual Meeting. Despite potential respondent bias, this suggests a promising avenue for leveraging established podcasts for post-conference information distribution.

Evidence linking COVID-19 and the health/well-being of children and adolescents: an umbrella review

BackgroundExperiences during childhood and adolescence have enduring impacts on physical and mental well-being, overall quality of life, and socioeconomic status throughout one’s lifetime. This underscores the importance of prioritizing the health of children and adolescents to establish an impactful healthcare system that benefits both individuals and society. It is crucial for healthcare providers and policymakers to examine the relationship between COVID-19 and the health of children and adolescents, as this understanding will guide the creation of interventions and policies for the long-term management of the virus.MethodsIn this umbrella review (PROSPERO ID: CRD42023401106), systematic reviews were identified from the Cochrane Database of Systematic Reviews; EMBASE (OvidSP); and MEDLINE (OvidSP) from December 2019 to February 2023. Pairwise and single-arm meta-analyses were extracted from the included systematic reviews. The methodological quality appraisal was completed using the AMSTAR-2 tool. Single-arm meta-analyses were re-presented under six domains associated with COVID-19 condition. Pairwise meta-analyses were classified into five domains according to the evidence classification criteria. Rosenberg’s FSN was calculated for both binary and continuous measures.ResultsWe identified 1551 single-arm and 301 pairwise meta-analyses from 124 systematic reviews that met our predefined criteria for inclusion. The focus of the meta-analytical evidence was predominantly on the physical outcomes of COVID-19, encompassing both single-arm and pairwise study designs. However, the quality of evidence and methodological rigor were suboptimal. Based on the evidence gathered from single-arm meta-analyses, we constructed an illustrative representation of the disease severity, clinical manifestations, laboratory and radiological findings, treatments, and outcomes from 2020 to 2022. Additionally, we discovered 17 instances of strong or highly suggestive pairwise meta-analytical evidence concerning long-COVID, pediatric comorbidity, COVID-19 vaccines, mental health, and depression.ConclusionsThe findings of our study advocate for the implementation of surveillance systems to track health consequences associated with COVID-19 and the establishment of multidisciplinary collaborative rehabilitation programs for affected younger populations. In future research endeavors, it is important to prioritize the investigation of non-physical outcomes to bridge the gap between research findings and clinical application in this field.

Epidemiologic Disparities and Challenges in Non-parkinsonian Tremor Disorders Research: A Scoping Review Emphasizing the Indian Context.

Non-parkinsonian tremors represent a heterogeneous spectrum of movement disorders where knowledge gaps persist regarding epidemiology, pathophysiology, and clinical burden. This scoping review aimed to systematically consolidate literature on these disorders in India across the domains of prevalence, biological mechanisms, psychiatric comorbidity, disability impact, and quality of life. A systematic search was undertaken across databases to identify studies on non-parkinsonian tremors in India. Extracted data were synthesized descriptively under themes spanning reported prevalence estimates and variability, proposed biological processes, psychiatric symptom rates, stigma perceptions, and quality-of-life deficits. Methodological appraisal was undertaken. Twenty-nine studies reported prevalence estimates displaying wide variability from 0.09% to 22% for essential tremor, partly attributable to definitional inconsistencies. Proposed pathologic processes centered on cerebellar dysfunction, neurotransmitter disturbances, and genetic risks. Nine studies revealed variable anxiety (6.8%-90%) and depression (3.4%-60%) rates among essential tremor patients, while two indicated perceived stigma. Five studies unanimously concurred significant quality of life impairment in essential tremors. Evidence of dystonic tremor, functional tremor, and other tremors was limited. This review exposed critical knowledge gaps and methodological limitations, while systematically evaluating the Indian literature on non-parkinsonian tremors concerning epidemiology, mechanisms, and clinical burden. Large-scale collaborative research applying standardized diagnostic criteria is imperative to determine contemporary prevalence statistics and comprehensively characterize the multifaceted disability footprint to inform patient-centric models optimizing diagnosis and holistic care.

Home-based exercise interventions' impact on breast cancer survivors' functional performance: a systematic review.

Home-based exercise (HBE) programs can be a feasible strategy to enhance functional performance and promote physical activity (PA) in breast cancer survivors. A deeper analysis of the effects of HBE interventions, structured by HBE program type and treatment phase, is needed. This systematic review aimed to synthesize the evidence on HBE interventions' impact on breast cancer survivors' functional performance, PA levels, and program adherence rates, according to HBE intervention type and treatment phase. A comprehensive search of peer-reviewed articles reporting HBE interventions' effects on the outcomes of interest was performed in Pubmed, Google Scholar, EBSCO, Web of Science, Science Direct, and B-ON until January 15th, 2024. Data were synthesized according to Denton's domains to classify HBE interventions (prescription: structured vs. unstructured; Delivery method: supervised vs. facilitated vs. unsupervised) and treatment phase. Methodological quality appraisal was performed using the Effective Public Health Practice Project tool. Twenty-six studies were included. Most studies conducted structured/facilitated interventions and reported positive effects on functional performance (particularly aerobic capacity), increases in PA levels, and high adherence rates (> 70%) during and post-treatment. HBE interventions may be feasible to improve functional performance and promote physical activity among breast cancer survivors. Further studies are needed to confirm which HBE intervention type is more appropriate for each treatment phase. More evidence applying HBE interventions with different designs is required to allow the drawing of more solid conclusions. Studies exploring the effects of HBE interventions on the pre-treatment phase are needed.

An integrative review of missed nursing care and the general practice nurse.

The phenomenon of missed care has received increasing interest over the past decade. Previous studies have used a missed care framework to identify missed nursing tasks, although these have primarily been within the acute care environment. The aim of this research was to identify missed care specific to the role of the general practice nurse. An integrative review method was adopted, using The Mixed Methods Appraisal Tool to assist in a methodological appraisal of both experimental, theoretical, and qualitative studies. Thematic analysis was then used to analyse and present a narrative synthesis of the data. CINAHL, SCOPUS, Web of Science and Google Scholar databases were searched between 2011 and 2022 for empirical research that reported missed care and the general practice nurse. Of the 787 papers identified, 10 papers met the inclusion criteria. Three themes identified missed care in relation to primary healthcare nurses: under-staffing and resourcing, communication difficulties, and role confusion. Isolating missed care by general practice nurses was challenging because much of the research failed to separate out general practice nurses from community and primary health care nurses. This challenge was exacerbated by disparity in the way that a general practice nurse is defined and presented in the various databases. While some themes such as those related to communication and understaffing and resourcing demonstrate some parallels with the acute sector, more research is required to identify missed care specific to the general practice nurse.

Integrative Review of the Impact of Coworker Support on Nurses’ Job Motivation: Associations with Job Satisfaction, Stress, and Intention to Stay

Background. Staff shortages in healthcare, especially nurses, are a worldwide problem with negative effects for both nurses and patients. Supporting nurses is important for job motivation and to strengthen connectedness and intention to stay. Extensive research has been performed in the past on managerial support, but this is not the case for coworker support for nurses. Therefore, it is important to gain knowledge about areas of focus of coworker support impacting nurses’ motivation to prevent the loss of motivation and turnover. Aim. To provide an overview of the current insights regarding coworker support’s impact on nurses’ motivation. Evaluation. A review was conducted using three computerized databases, Web of Science, CINAHL, and PsycINFO. A total of 15 studies matched the inclusion criteria (association between nurses’ motivation and perceived coworker support and participants fulfilling the role of nurse). Coworker support was one of the main focuses of the included papers. Review Methods. Whittemore and Knafl’s (2005) method of the integrative literature review was used, together with the critical appraisal tool by Hawker et al. (2002) to guide the methodological rigor appraisal of the included research studies. Result. Three main themes regarding associations related to the effect of perceived coworker support on nurses were identified, namely, job satisfaction, intention to stay, and stress. Conclusions. This review shows multiple areas of focus where coworker support is important for the perceived support of nurses, with emphasis on job satisfaction, intention to stay, and stress. Support foresees job satisfaction. With the intention to stay, the effect of experienced support is especially seen among the newly qualified nurses, where lack of support increases the likelihood of leaving their jobs prematurely. Experienced support from coworkers also has a stress‐reducing effect. Implications for Nursing Forum. Support from coworkers is essential for nurses, as it has a positive effect on work satisfaction, intention to stay, and stress reduction. It is important to create a work environment that offers room for coworker support.

Appraisal of Structural Integrity Assessment Methodology and Reports of Existing RC Building Structures in Ghana

This study reviewed eighty-three (83) structural integrity reports obtained from two (2) Metropolitan and six (6) Municipal Assemblies in the Greater Accra Region of Ghana to ascertain the availability of national standard assessment methodology and reporting format for structural integrity assessment of existing building structures in Ghana, evaluate test methods and techniques used in the assessment, and ascertain justification for recommended intervention levels. A case study with a special form/instrument was designed to collect the required data from the reviewed reports in response to the study objectives. The study revealed that there are no national standards or published guidelines available for a methodology for structural integrity assessment and reporting format for existing building structures in Ghana, resulting in a wide variation in the reporting structure by experts or consultants. The most widely used test methods and techniques (and their frequency of use) were visual inspections (100%), Non-Destructive Tests by Schmidt Hammer (95%), Covermeter (40%), Dynamic Cone Penetration Test (DCPT) (48%), and Trial Pits (55%); however, equipment specifications for the test methods and techniques were generally not stated in the reports. The justification for the assessments was largely for structural adequacy and safety assessment for regularization (code compliance), repair, rehabilitation, upgrading, extension or change of use. While only 31% of the reports reviewed provided information on analysis and design calculations, most reports recommended a ‘safe structure’ irrespective of the depth/adequacy of investigation and information provided in the reports. A national standard reporting format was therefore developed and recommended for adoption in the activity of Structural Integrity Assessment and reporting for existing RC building structures in Ghana and beyond.

Effectiveness of health literacy interventions on the health outcomes of higher education students

Abstract Background Health literacy is relevant to the empowerment process of higher education students. It reduces their vulnerability in health decision making. Higher education institutions are planning, implementing, and evaluating health literacy interventions on a variety of topics and using a variety of methodologies in order to achieve health benefits for their participants. Benefits in disease prevention, health promotion and health care have been associated with health literacy interventions. A review was conducted to identify and synthesise evidence on the effectiveness of health literacy interventions delivered in academic settings on the health outcomes of higher education students. Methods A systematic review of the literature was conducted with research on the EBSCO Host-Research Databases platform. The methodology followed the PRISMA guidelines, and the protocol was registered with PROSPERO. Methodological appraisal of the studies was carried out according to the Joanna Briggs Institute appraisal tool. A thematic and narrative synthesis was carried out for literature synthesis. Results This review included 9 articles out of 154 identified. The health gains of health literacy interventions in academic settings were positive changes in mental health; attitudes, norms, and self-efficacy for condom use; emotional, social, and psychological wellbeing; subjective sleep quality, sleep latency, and habitual sleep efficiency; physical activity; and self-reported servings of fried foods. The educational or motivational health literacy interventions contributed to health promotion, disease prevention or healthcare. Conclusions The variety of health literacy interventions that are delivered in an academic setting contributes to positive changes in the health outcomes of students in higher education. Investing in the design and delivery of health literacy interventions is one way to reduce their health vulnerability and protect them from the threats. Key messages • When planning health literacy interventions, it is important to know what health benefits they bring. • Health literacy interventions in an academic setting are important for health outcomes.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses.

Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery. To investigate the global prevalence of overweight and obesity among nurses. Systematic review with meta-analysis. 29 different countries across the WHO-classified geographical region. Nurses. Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic. Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators. This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health. Not applicable as this is a systematic review. PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785. High prevalence of overweight and obesity among nurses worldwide.

Oxygen saturation targets for children with respiratory distress: a systematic review.

In children with respiratory distress, supplemental oxygen is indicated at peripheral oxygen saturation (SpO2) thresholds of 90-94%. However, these thresholds are poorly studied. We conducted a systematic review to summarise the existing evidence for SpO2 thresholds in children with respiratory distress. Electronic databases and registries were searched for original articles published from 1 January 2010 to 7 January 2022 comparing two or more SpO2 thresholds in children with respiratory distress. Primary outcomes were safety, including mortality, neurocognitive outcomes and readmissions, and effectiveness, including admission rate and length of hospital stay. Methodological appraisal was performed using the Cochrane Risk of Bias 2 (RoB-2) or Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) tools. Results were narratively synthesised. We retrieved 3384 results; seven studies were included. Lower thresholds ranged from 80% to 92% and were compared with higher thresholds ranging from 92% to 94%. Studies were highly heterogeneous in setting, design, population and outcomes. Risk of bias varied from low to high. Lower SpO2 thresholds had equivalent mortality, neurocognitive outcomes and readmissions or re-attendance to healthcare to higher thresholds. Lower SpO2 thresholds showed a significant decrease in admission rates by up to 40% and shortened hospitalisation duration by 10-18 h. The current SpO2 thresholds of 90-94% in children with respiratory distress may be too high, which could lead to unnecessary hospitalisations and prolonged hospitalisation duration. SpO2 thresholds as low as 88% are potentially safe in children with respiratory distress and may reduce hospitalisation rates and length of stay. However, high-quality evidence is needed to support this.

Viscoelastic testing: Critical appraisal of new methodologies and current literature.

United States Food and Drug Administration (FDA)-approved viscoelastic testing (VET) methodologies have significantly changed in the last 10 years, with the availability of cartridge-based VET. Some of these cartridge-based methodologies use harmonic resonance-based clot detection. While VET has always allowed for the evaluation of real-time clot formation, cartridge-based VET provides increased ease of use as well as greater portability and robustness of results in out-of-laboratory environments. Here we review the use of VET in a variety of clinical contexts, including cardiac surgery, trauma, liver transplant, obstetrics, and hypercoagulable states such as COVID-19. As of now, high quality randomized trial evidence for new generation VET (TEG 6s, HemoSonics Quantra, ROTEM sigma) is limited. Nevertheless, the use of VET-guided transfusion algorithms appears to result in reduced blood usage without worsening of patient outcomes. Future work comparing the new generation VET instruments and continuing to validate clinically important cut-offs will help move the field of point-of-care coagulation monitoring forward and increase the quality of transfusion management in bleeding patients.

Language-Specific Dual-Task Effects After Stroke: A Systematic Review.

The dual-task paradigm has been frequently used to examine stroke-related deficits because it samples behavioral performance under conditions of distraction similar to functioning in real-life environments. This original systematic review synthesizes studies that examined dual-task effects involving spoken language production in adults affected by stroke, including transient ischemic attack (TIA) and poststroke aphasia. Five databases were searched (inception to March 2022) for eligible peer-reviewed articles. The 21 included studies reported a total of 561 stroke participants. Thirteen studies focused on single word production, for example, word fluency, and eight on discourse production, for example, storytelling. Most studies included participants who had suffered a major stroke. Six studies focused on aphasia, whereas no study focused on TIA. A meta-analysis was not appropriate because of the heterogeneity of outcome measures. Some single word production studies found dual-task language effects whereas others did not. This finding was compounded by the lack of appropriate control participants. Most single word and discourse studies utilized motoric tasks in the dual-task condition. Our certainty (or confidence) assessment was based on a methodological appraisal of each study and information about reliability/fidelity. As 10 of the 21 studies included appropriate control groups and limited reliability/fidelity information, the certainty of the findings may be described as weak. Language-specific dual-task costs were identified in single word studies, especially those that focused on aphasia as well as half of the nonaphasia studies. Unlike single word studies, nearly all studies of discourse showed dual-task decrements on at least some variables. https://doi.org/10.23641/asha.23605311.

What are the holistic care impacts among individuals living through the COVID-19 pandemic in residential or community care settings? An integrative systematic review.

To critically synthesise evidence in relation to the holistic care impacts (physical, psychological, social, spiritual, and environmental well-being) among individuals living in residential aged care facilities (RACFs) with restrictions during the COVID-19 pandemic. An integrative systematic review followed a pre-registered protocol and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were searched from inception to June 2022. Qualitative, quantitative, and mixed methods studies were included. All articles were double screened according to a pre-determined eligibility criterion. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. 18 studies were included. The impact of restrictive practices and periods of lockdown impacted older people on all levels of individual quality-of-life. With or without COVID-19, residents experienced functional decline and many experienced malnutrition, increased incontinence, increased pain, and poorer general health and significant psychological distress. Depression increased with reduced social contact, as did anxiety and loneliness. Some residents spoke of suicidal ideation. It is highly plausible that further outbreaks may prompt knee-jerk reactions from public health departments and governing bodies to continue to restrict and lockdown facilities. Public health COVID-19 outbreak policy for aged care across the globe will need to consider the benefits verses risk debate given the findings uncovered in this review. These findings showed that it is vital that policy considers quality-of-life domains not solely survival rates.

Factors that influence the implementation of (inter)nationally endorsed health and social care standards: a systematic review and meta-summary

BackgroundHealth and social care standards have been widely adopted as a quality improvement intervention. Standards are typically made up of evidence-based statements that describe safe, high-quality, person-centred care as an...

Methodological Appraisal of Phase 3 Clinical Trials in Geographic Atrophy.

Geographic atrophy (GA) secondary to age-related macular degeneration is a common cause of blindness worldwide. Given the recent approval of the first therapy for GA, pegcetacoplan, we critically appraise methodological aspects of the phase 3 clinical trials published so far in this disease in relation to their design, analysis and interpretation. We reviewed some of the key attributes of all phase 3 clinical trials in GA available in the main public registry of clinical trials as of 20 May 2023. The topics discussed included types of endpoints, eligibility criteria, p-value and effect size, study power and sample size, the intention to treat principle, missing data, consistency of results, efficacy-safety balance and application of results. Five phase 3 clinical trials have reported results, either partially or completely: GATHER1, DERBY/OAKS, CHROMA/SPECTRI, SEATTLE and GATE. Although there are many similarities between these trials in terms of endpoints or broad eligibility criteria, they differ in several aspects (metric of the primary endpoint, sample size, type of adverse events, etc.) that can influence the results, which are discussed. Readers should understand key methodological aspects of clinical trials to improve their interpretation. On the other hand, authors should adhere to clinical trial reporting guidelines to communicate what was done and how it was done.