Best-evidence Synthesis Research Articles

Neuroprotective Drugs in Infants With Severe Congenital Heart Disease: A Systematic Review.

Background: Perinatal and perioperative brain injury is a fundamental problem in infants with severe congenital heart disease undergoing neonatal cardiac surgery with cardiopulmonary bypass. An impaired neuromotor and neurocognitive development is encountered and associated with a reduction in quality of life. New neuroprotective drugs during surgery are described to reduce brain injury and improve neurodevelopmental outcome. Therefore, our aim was to provide a systematic review and best-evidence synthesis on the effects of neuroprotective drugs on brain injury and neurodevelopmental outcome in congenital heart disease infants requiring cardiac surgery with cardiopulmonary bypass.Methods: A systematic search was performed in PubMed, Embase and the Cochrane Library (PRISMA statement). Search terms were “infants,” “congenital heart disease,” “cardiac surgery,” “cardiopulmonary bypass,” and “neuroprotective drug.” Data describing the effects on brain injury and neurodevelopmental outcome were extracted. Study quality was assessed with the Cochrane Risk of Bias Tool. Two reviewers independently screened sources, extracted data and scored bias. Disagreements were resolved by involving a third researcher.Results: The search identified 293 studies of which 6 were included. In total 527 patients with various congenital heart diseases participated with an average of 88 infants (13–318) per study. Allopurinol, sodium nitroprusside, erythropoietin, ketamine, dextromethorphan and phentolamine were administered around cardiac surgery with cardiopulmonary bypass. Allopurinol showed less seizures, coma, death and cardiac events in hypoplastic left heart syndrome (HLHS) infants (OR: 0.44; 95%-CI:0.21–0.91). Sodium nitroprusside resulted in lower post cardiopulmonary bypass levels of S100ß in infants with transposition of the great arteries after 24 (p < 0.01) and 48 (p = 0.04) h of treatment. Erytropoietin, ketamine and dextromethorphan showed no neuroprotective effects. Phentolamine led to higher S100ß-levels and cerebrovascular resistance after rewarming and at the end of surgery (both p < 0.01). Risk of bias varied between studies, including low (sodium nitroprusside, phentolamine), moderate (ketamine, dextromethorphan), and high (erytropoietin, allopurinol) quality.Conclusions: Allopurinol seems promising for future trials in congenital heart disease infants to reduce brain injury given the early neuroprotective effects in hypoplastic left heart syndrome infants. Larger well-designed trials are needed to assess the neuroprotective effects of sodium nitroprusside, erytropoietin, ketamine and dextromethorphan. Future neuroprotective studies in congenital heart disease infants should not only focus on the perioperative period, however also on the perinatal period, since significant brain injury already exists before surgery.

The association between pro-inflammatory biomarkers and nonspecific low back pain: a systematic review.

About 85% of the patients with low back pain seeking medical care have nonspecific low back pain (NsLBP), implying that no definitive cause can be identified. Nonspecific low back pain is defined as low back pain and disability which cannot be linked to an underlying pathology, such as cancer, spinal osteomyelitis, fracture, spinal stenosis, cauda equine, ankylosing spondylitis, and visceral-referred pain. Many pain conditions are linked with elevated serum levels of pro-inflammatory biomarkers. Outcomes of interest are NsLBP and the level of pro-inflammatory biomarkers. To unravel the etiology and get better insight in the prognosis of NsLBP, the aim of this study was to assess the association between pro-inflammatory biomarkers and the presence and severity of NsLBP. A systematic literature search was made in Embase, Medline, Cinahl, Webof-science, and Google scholar up to January 19th 2017. Included were cross-sectional and cohort studies reporting on patients aged over 18 years with NsLBP, in which one or more pro-inflammatory biomarkers were measured in blood plasma. The methodological quality of the included studies was assessed using the Newcastle Ottawa Scale. A best-evidence synthesis was used to summarize the results from the individual studies, meaning that the included studies were ranked according to the consistency of the findings and according to their methodological quality score using the Newcastle Ottawa Scale. Included were 10 studies which assessed four different pro-inflammatory biomarkers. For the association between the presence of NsLBP and C-reactive protein (CRP), interleukin 6 (IL-6) and tumor necrosis factor (TNF)-α limited, conflicting and moderate evidence, respectively, was found. For the association between the severity of NsLBP and CRP and IL-6, moderate evidence was found. For the association between the severity of NsLBP and TNF-α and RANTES Regulated on Activation, Normal T Cell Expressed and Secreted conflicting and limited evidence, respectively, was found. This study found moderate evidence for (i) a positive association between the pro-inflammatory biomarkers CRP and IL-6 and the severity of NsLBP, and (ii) a positive association between TNF-α and the presence of NsLBP. Conflicting and limited evidence was found for the association between TNF-α and Regulated on Activation, Normal T Cell Expressed and Secreted and severity of NsLBP, respectively.

Effects of Mat Pilates on Physical Functional Performance of Older Adults: A Meta-analysis of Randomized Controlled Trials.

The present meta-analysis aimed to examine evidence from randomized controlled trials to determine the effects of mat Pilates on measures of physical functional performance in the older population. A search was conducted in the MEDLINE/PubMed, Scopus, Scielo, and PEDro databases between February and March 2017. Only randomized controlled trials that were written in English, included subjects aged 60 yrs who used mat Pilates exercises, included a comparison (control) group, and reported performance-based measures of physical function (balance, flexibility, muscle strength, and cardiorespiratory fitness) were included. The methodological quality of the studies was analyzed according to the PEDro scale and the best-evidence synthesis. The meta-analysis was conducted with the Review Manager 5.3 software. The search retrieved 518 articles, nine of which fulfilled the inclusion criteria. High methodological quality was found in five of these studies. Meta-analysis indicated a large effect of mat Pilates on dynamic balance (standardized mean difference = 1.10, 95% confidence interval = 0.29-1.90), muscle strength (standardized mean difference = 1.13, 95% confidence interval = 0.30-1.96), flexibility (standardized mean difference = 1.22, 95% confidence interval = 0.39-2.04), and cardiorespiratory fitness (standardized mean difference = 1.48, 95% confidence interval = 0.42-2.54) of elderly subjects. There is evidence that mat Pilates improves dynamic balance, lower limb strength, hip and lower back flexibility, and cardiovascular endurance in elderly individuals. Furthermore, high-quality studies are necessary to clarify the effects of mat Pilates on other physical functional measurements among older adults.

The Association of Illness Perception and Prognosis for Pain and Physical Function in Patients With Noncancer Musculoskeletal Pain: A Systematic Literature Review.

In the literature, illness perceptions have been reported to be important psychological factors associated with pain intensity and physical function in individuals with musculoskeletal pain. To assess the relationship of illness perceptions with pain intensity and physical function in individuals with noncancer musculoskeletal pain. In this systematic review, relevant literature databases, including PubMed, Embase, PsycINFO, CINAHL, and SPORTDiscus, were searched from inception through December 12, 2017. Two authors (E.D.R. and H.W.) independently performed the search procedures, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the A MeaSurement Tool to Assess systematic Reviews guidelines, and the risk-of-bias assessment, using the QUality In Prognosis Studies tool. A qualitative best-evidence synthesis was performed. A total of 26 articles were included in the review. There were 11 cross-sectional studies concerning associations of illness perceptions with pain intensity and 11 cross-sectional studies of associations of illness perceptions with physical function. For the prognosis of pain intensity by illness perceptions, the authors found 4 longitudinal studies, and for the prognosis of physical function by illness perceptions, the authors found 12 longitudinal studies. All studies except 1 had high risk of bias. Across 15 cross-sectional studies on 9 different musculoskeletal conditions, the researchers found limited to moderate evidence for a consistent direction of the relationship of illness perceptions with pain intensity and physical function. Higher maladaptive illness perceptions imply stronger pain intensity and more limitation in physical function. Evidence in longitudinal studies is lacking, especially on pain. There is limited to moderate evidence for the cross-sectional relationship between illness perceptions and various musculoskeletal conditions. The prognostic value, however, remains unclear. Future research is recommended to investigate the longitudinal relationship between illness perception domains and outcomes in greater detail. J Orthop Sports Phys Ther 2018;48(10):789-800. Epub 10 May 2018. doi:10.2519/jospt.2018.8072.

The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis.

Acne vulgaris is a multifaceted skin disorder, affecting more than 85% of young individuals worldwide. Pharmacological therapy is not always desirable because of the development of antibiotic resistance or the potential risk of adverse effects. Non-pharmacological therapies can be viable alternatives for conventional therapies. However, sufficient evidence-based support in the efficacy and safety of non-pharmacological therapies is lacking. To assess the efficacy and safety of several non-pharmacological therapies in the treatment of acne vulgaris. A systematic literature review, including a best-evidence synthesis, was performed to identify literature. Three electronic databases were accessed and searched for studies published between January 2000 and May 2017. Thirty-three eligible studies were included in our systematic review. Three main types of non-pharmacological therapies were identified laser- and light-based therapies, chemical peels and fractional microneedling radiofrequency. The majority of the included studies demonstrated a significant reduction in acne lesions. However, only seven studies had a high methodologic quality. Based on these seven trials, a best-evidence synthesis was conducted. Strong evidence was found for glycolic acid (10-40%). Moderate evidence was found for amino fruit acid (20-60%), intense pulsed light (400-700 and 870-1200 nm) and the diode laser (1450 nm). Initially, conflicting evidence was found for pulsed dye laser (585-595 nm). The most frequently reported side-effects for non-pharmacological therapies included erythema, tolerable pain, purpura, oedema and a few cases of hyperpigmentation, which were in most cases mild and transient. Circumstantial evidence was found for non-pharmacological therapies in the treatment of acne vulgaris. However, the lack of high methodological quality among included studies prevented us to draw clear conclusions, regarding a stepwise approach. Nevertheless, our systematic review including a best-evidence synthesis did create order and structure in resulting outcomes in which a first step towards future research is generated.

The effects of early life polyunsaturated fatty acids and ruminant trans fatty acids on allergic diseases: A systematic review and meta-analysis

ABSTRACTEarly life nutritional exposures could modify the gene expression and susceptibility of allergic diseases (AD). This systematic review aimed to evaluate whether early life (the first 1,000 days) natural exposure to polyunsaturated fatty acids (PUFA) and ruminant trans fatty acids (R-TFA) could affect the AD risk. We searched PubMed, EMBASE, PsycINFO, Scopus, the Cochrane Library, and ClinicalTrials.gov from inception through September 10, 2017 for relevant full-text articles in English. Observational studies were selected if they examined the effects of early life PUFA or R-TFA on AD (eczema, asthma, wheeze, and allergic rhinitis) or sensitization. The quality of studies was examined by the Newcastle-Ottawa Scale, and the best evidence synthesis (BES) was applied. We included 26 observational studies, and 8 of them showed high quality. BES showed a moderate evidence for the protective effect of vaccenic acid (VA, an R-TFA) on eczema, while insufficient or no evidence was found in other associations. Meta-analysis showed that higher n-6/n-3 ratio and linoleic acid were associated with higher risk of eczema (pooled odds ratio [OR] = 1.06, 95% confidence intervals [CI]: 1.00 −1.13; 1.08, 95% CI: 1.01 −1.15). However, VA was inversely associated with eczema pooled OR = 0.42, 95% CI: 0.25 −0.72). Early life natural exposure to VA showed evident benefit on decreasing the risk of eczema, while PUFA and other R-TFA showed limited effects on AD. More robust studies especially for R-TFA are required.

The quality of instruments to assess the process of shared decision making: A systematic review.

ObjectiveTo inventory instruments assessing the process of shared decision making and appraise their measurement quality, taking into account the methodological quality of their validation studies.MethodsIn a systematic review we searched seven databases (PubMed, Embase, Emcare, Cochrane, PsycINFO, Web of Science, Academic Search Premier) for studies investigating instruments measuring the process of shared decision making. Per identified instrument, we assessed the level of evidence separately for 10 measurement properties following a three-step procedure: 1) appraisal of the methodological quality using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist, 2) appraisal of the psychometric quality of the measurement property using three possible quality scores, 3) best-evidence synthesis based on the number of studies, their methodological and psychometrical quality, and the direction and consistency of the results. The study protocol was registered at PROSPERO: CRD42015023397.ResultsWe included 51 articles describing the development and/or evaluation of 40 shared decision-making process instruments: 16 patient questionnaires, 4 provider questionnaires, 18 coding schemes and 2 instruments measuring multiple perspectives. There is an overall lack of evidence for their measurement quality, either because validation is missing or methods are poor. The best-evidence synthesis indicated positive results for a major part of instruments for content validity (50%) and structural validity (53%) if these were evaluated, but negative results for a major part of instruments when inter-rater reliability (47%) and hypotheses testing (59%) were evaluated.ConclusionsDue to the lack of evidence on measurement quality, the choice for the most appropriate instrument can best be based on the instrument’s content and characteristics such as the perspective that they assess. We recommend refinement and validation of existing instruments, and the use of COSMIN-guidelines to help guarantee high-quality evaluations.

Does the amount of lower extremity movement variability differ between injured and uninjured populations? A systematic review.

Movement variability during repetitive performance of a dynamic activity (eg, running, jumping, kicking) is considered an integral characteristic of optimal movement execution; however, its relationship with musculo-skeletal injury is not known. The primary aim of this study was to review published comparison trials to determine whether movement variability differs between uninjured controls and subjects with a lower limb musculo-skeletal injury. A systematic search of online databases; MEDLINE, Sports Discus, Scopus, and Web of Science was conducted from July to November 2016. Studies were selected if they (a) included participants with a lower limb injury, (b) compared injured participants to uninjured controls, (c) examined movement variability for at least one dependent variable, and (d) provided a statistical between-group comparison when comparing measures of movement variability. Studies were excluded if they (a) investigated neurological disorders, (b) examined musculo-skeletal injury in the upper extremity or spine, and (c) used nonlinear measures to examine variability (ie, complexity). A significant difference between injured and uninjured populations was reported in 73% of the included studies, and of these, 64% reported greater movement variability in the injured group. This is the first systematic review with a best-evidence synthesis investigating the association between movement variability and musculo-skeletal injury. Findings suggest that movement variability in those with a musculo-skeletal injury differs from uninjured individuals. Interestingly, there was an overall trend toward greater movement variability being associated with the injured groups, although it should be noted that this trend was not consistent across all subcategories (eg, injury type). For a clearer insight into the clinical application of variability, greater methodological homogeneity is required and prospective research is recommended.

Are Hispanic, Asian, Native American, or Language-Minority Children Overrepresented in Special Education?

We conducted a best-evidence synthesis of 22 studies to examine whether systemic bias explained minority disproportionate overrepresentation in special education. Of the total regression model estimates, only 7/168 (4.2%), 14/208 (6.7%), 2/37 (5.4%), and 6/91 (6.6%) indicated statistically significant overrepresentation for Hispanic, Asian, Native American, and English language learner (ELL) or language-minority children, respectively. Among studies with the strongest internal and external validity, none of the 90 estimates (i.e., 0%) indicated overrepresentation attributable to racial or ethnic bias. Of the 18 estimates for language-minority and ELL children combined, only 3 (16.7%) indicated overrepresentation attributable to language use. Two of the 4 ELL-specific estimates (50%) indicated that children receiving English-as-a-second-language services may be overrepresented in special education. Overall, and replicating findings from a prior best-evidence synthesis, this synthesis indicated that children are underidentified as having disabilities based on their race or ethnicity and language use.

The significance of context for the emergence and implementation of research evidence: the case of collaborative problem-solving

One of the fundamental purposes of educational research is to provide evidence to facilitate effective practice. However, the evidence itself does not have much value for practitioners unless key information about the context from which the evidence was generated is also provided. In this paper, we use the word ‘context’ to refer to factors that are relevant for learning, including the interactions that learners experience with multiple people, artefacts, and environments. Unfortunately, in many educational research studies, either these factors do not get the required attention or information about them is presented in an incoherent structure. The resultant lack of information leads to two significant drawbacks. First, it creates confusion among practitioners who want to apply research evidence in their practice. Second, it leads to research studies that on the face of it are similar, but that in reality have resulted from evidence that has been collected in significantly different contexts being included under the same categories in reviews, meta-reviews, and best-evidence syntheses. In this paper, we draw on the concept of ‘relatability’ of evidence and present taxonomy for collaborative problem-solving (CPS) that can be used to provide the valuable information against which research evidence can be indexed. By addressing the need for more detailed information about the contextual factors from which the evidence is generated to bridge the gap between research and practice in CPS research, we aim to exemplify the approach that is needed in educational research more generally.

Orthopaedic manifestations within the 22q11.2 Deletion syndrome: A systematic review.

The 22q11.2 Deletion Syndrome (22q11.2DS) is the most common microdeletion syndrome with an estimated prevalence of 1:4,000 live births. 22q11.2DS is known to have wide phenotypic variability, including orthopaedic manifestations. The purpose of this systematic review is to increase the awareness of orthopaedic manifestations associated with 22q11.2DS. This systematic review was performed according to the PRISMA Guidelines. Original epidemiological studies on the prevalence of orthopaedic manifestations within 22q11.2DS were systematically searched for in PubMed and EMBASE. The included articles were scored according to a risk-of-bias tool, a best-evidence synthesis was performed and the prevalence data was extracted. Sixty-nine published manuscripts described 58 orthopaedic manifestations in a total of 6,055 patients. The prevalence of at least one cervical or occipital anomaly is 90.5-100% (strong evidence). Fourteen studies (n = 2,264) revealed moderate evidence for a wide scoliosis prevalence of 0.6-60%. Two studies demonstrated that 5-6.4% of all 22q11.2DS patients required surgical scoliosis correction. Fifteen studies (n = 2,115) reported a 1.1-13.3% prevalence of clubfoot with moderate evidence. Other reported orthopaedic manifestations are patellar dislocation (10-20%), juvenile rheumatic arthritis (3.75%), impaired growth and skeletal anomalies like polydactyly (1.0-3.7%), syndactyly (11-11.8%), butterfly vertebrae (11.1%) and 13 ribs (2-19%). Orthopaedic findings are important manifestations of the 22q11.2DS, both in bringing patients to diagnostic attention and in requiring surveillance and appropriate intervention. Data on these manifestations are scattered and incomprehensive. Routinely screening for cervical anomalies, scoliosis, and upper and lower limb malformations is recommended in this vulnerable group of patients.

Workplace Interventions to Reduce Sedentary Behavior: A Systematic Review

Sedentary behaviour is a health risk factor independent of physical activity. Interventions that aim to reduce sitting at the workplace are particularly important as office workers spend a large proportion of their working hours sitting. This systematic review examines whether these interventions (SB or PA interventions during work time) reduce sitting time among office workers and which variables moderate intervention effects. A systematic literature search was conducted from April to May 2016 in the following databases: PubMed, PsycINFO and SPORTDiscus. In total, we identified 17 studies that assessed the time spent in sedentary behaviour at the office workplace. To summarize the study results, we applied a best-evidence synthesis. Additionally, we evaluated potential moderators, such as intervention strategies. Multi-component interventions and sit-stand workstations were most promising sedentary reduction interventions. The analysis of moderators highlighted that the proportion of positive intervention effects was higher in interventions based on the strategies "environmental restructuring", "adding objects to the environment" and "instructions on how to carry out the behaviour". Furthermore, interventions focusing on sedentary behaviour only and studies using objective measurement tools showed more often positive interventions effects. There are many promising interventions to reduce sitting time at the office workplace. However, there is insufficient evidence if the effects of these interventions are sustainable in the long term. Moreover, the considerable heterogeneity of included studies limits the validity of our findings. Future intervention studies should build on a theoretical planning approach and use subjective as well as objective evaluation measures.

Efficacy of Platelet-Rich Plasma in Pain and Self-Report Function in Knee Osteoarthritis: A Best-Evidence Synthesis.

The aim of this study was to assess the efficacy of platelet-rich plasma (PRP) in pain and self-report function of patients with knee osteoarthritis on the basis of comparisons with hyaluronic acid or placebo. Best-evidence synthesis of randomized controlled trials (RCTs) was conducted. Literature retrieval was limited to RCTs assessing the efficacy of PRP in knee osteoarthritis. Methodology evaluation and data extraction were based on Cochrane Collaboration guidelines. Meta-analyses were performed using mean difference or standardized mean difference as effect size. Ten RCTs were included and analyzed. Meta-analysis showed significant superiority of PRP in outcome scores when compared with hyaluronic acid (standardized mean difference = -0.85, P = 0.004, I = 93%), but no statistical difference was found in well-designed double-blind trials (standardized mean difference = -0.09, P = 0.38, I = 0%). Pooled standardized mean difference of trials comparing PRP with placebo directly was -2.13 (95% confidence interval = -3.29 to -0.98), and that of indirect comparison was -0.22 (95% confidence interval = -0.45 to -0.01). In relieving pain and improving self-report function, PRP showed no superiority over hyaluronic acid in well-designed double-blind trials, and beneficial effects of PRP in most trials probably resulted from insufficient blinding methods. However, PRP is still considered more effective than placebo on the basis of present evidence.

Factors Associated With Higher Caregiver Burden Among Family Caregivers of Elderly Cancer Patients: A Systematic Review.

Caring for elderly cancer patients may cause multidimensional burden on family caregivers. Recognition of factors associated with caregiver burden is important for providing proactive support to caregivers at risk. The aim of this study was to identify factors associated with high caregiver burden among family caregivers of elderly cancer patients. A systematic search of 7 electronic databases was conducted from database inception to October 2014. The identified studies were screened, and full text was further assessed. The quality of included studies was assessed using a checklist, and relevant data were extracted using a predeveloped data extraction form. Best-evidence synthesis model was used for data synthesis. The search yielded a total of 3339 studies, and 7 studies involving 1233 family caregivers were included after screening and full assessment of 116 studies. Moderate evidence supported that younger caregivers, solid tumors, and assistance with patient's activities of daily living were significantly associated with high caregiver burden. Eighteen factors were supported by limited evidence, and 1 was a conflicting factor. The scientific literature to date proved that caregiver burden was commonly experienced by family caregivers of elderly cancer patients. The evidence indicated that family caregivers who were at younger age, caring for solid tumor patients, and providing assistance with patient's activities of daily living reported high caregiver burden. The data provide evidence in identifying family caregivers at high risk of high caregiver burden. More high-quality studies are needed to clarify and determine the estimates of the effects of individual factors.

The Role of Lateral Extra-articular Tenodesis in Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review With Meta-analysis and Best-Evidence Synthesis.

Background:The role of lateral extra-articular tenodesis (LEAT) to augment primary anterior cruciate ligament reconstruction (ACLR) remains controversial.Purpose:To determine whether the addition of LEAT to primary ACLR provides greater control of rotational laxity and improves clinical outcomes compared with ACLR alone and to assess the impact of early versus delayed ACLR.Study Design:Systematic review; Level of evidence, 3.Methods:Two reviewers independently searched 7 databases for randomized and nonrandomized clinical studies comparing ACLR plus LEAT versus ACLR alone. Animal, cadaveric, and biomechanical studies; revision or repair procedures; and studies using synthetic ligaments and multiligamentous-injured knees were excluded. Risk of bias was assessed with a modified Downs and Black checklist. The primary outcome was postoperative pivot shift. These data were pooled by use of a fixed-effects meta-analysis model. The studies were divided into delayed (>12 months) and early (≤12 months) reconstruction groups for meta-analysis. A best-evidence synthesis was performed on the remaining outcome measures.Results:Of 387 titles identified, 11 articles were included (5 of high quality). Meta-analysis of postoperative pivot shift in 3 studies of delayed primary ACLR showed a statistically significant difference for the pivot-shift test in favor of ACLR with LEAT (odds ratio [OR], 0.44; 95% confidence interval [CI], 0.24-0.81; P = .008; I 2 = 0). Meta-analysis of 5 studies of early primary ACLR found no statistically significant difference with the addition of LEAT (OR, 0.60; 95% CI, 0.33-1.09; P = .10; I 2 = 33%). Insufficient evidence was available to determine whether the addition of LEAT had any effect on clinical, objective, subjective, and functional outcomes.Conclusion:In primary ACLR, no evidence is available showing additional benefit of LEAT in reducing the postoperative pivot shift in early reconstructions (≤12 months); however, LEAT may have a role in delayed ACLR. Strong evidence exists that a combined ACLR and LEAT reduces lateral femoral translation, but there is insufficient evidence to identify any benefit for other clinical outcomes.

Common Psychosocial Factors Predicting Return to Work After Common Mental Disorders, Cardiovascular Diseases, and Cancers: A Review of Reviews Supporting a Cross-Disease Approach.

Purpose This systematic review aimed at identifying the common psychosocial factors that facilitate or hinder the return to work (RTW) after a sick leave due to common mental disorders (CMDs), cardiovascular diseases (CVDs), or cancers (CAs). Methods We conducted a review of reviews searching 13 databases from 1994 to 2016 for peer-reviewed, quantitative, cohort studies investigating factors influencing RTW after a CMD, CVD, or CA. Then, for each disease we identified additional cohort studies published after the date of the latest review included. Data were extracted following a three steps best-evidence synthesis method: the extraction of results about each predictor from studies within each single review and in the additional papers; the synthesis of results across the reviews and additional papers investigating the same disease; and the synthesis of results across the diseases. Results The search strategy identified 1029 unique records from which 27 reviews and 75 additional studies underwent comprehensive review. 14 reviews and 32 additional cohort studies met eligibility criteria. Specific predictors of RTW with different levels of evidence are provided for each disease. We found four common facilitators of RTW (job control, work ability, perceived good health and high socioeconomic status), and six barriers of RTW (job strain, anxiety, depression, comorbidity, older age and low education). Conclusion This is the first review to systematically analyze commonalities in RTW after CMDs, CVDs, or CAs. The common factors identified indicate that the RTW process presents many similarities across various diseases, thus supporting the validity of a cross-disease approach.

Healthcare interventions for the prevention and control of gestational diabetes mellitus in China: a scoping review

BackgroundGestational Diabetes Mellitus (GDM) is a type of diabetes which occurs during pregnancy. Women with GDM are at greater risk of complications during pregnancy and delivery, while babies born from mothers with GDM are at greater risk of post-natal complications. Using the most updated diagnosis criteria, the GDM prevalence is estimated at 9.3–25.5% worldwide and 9.3–18.9% in China. Our objective was to identify healthcare interventions aimed at GDM prevention and control in China.MethodsA best-evidence synthesis was performed based on a systematic search of literature published between 1997 and October 2015 in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), and Wan-fang databases using keywords “Gestational Diabetes Mellitus”, “GDM”, “Intervention” “Medical Intervention” “Early Medical Intervention”, “Dietary Intervention”, “Exercise Intervention”, “Lifestyle Intervention”, “Therapy”, “Treatment” and “China”. Inclusion criteria were studies conducted in China, reporting GDM healthcare interventions, and published in either Chinese or English. Two reviewers independently assessed eligibility and quality of the studies and extracted the data. Treatment efficacy was examined with weighted pooled odds ratio (OR) meta-analyses.ResultsThe search resulted in 5961 articles (published in 276 different Chinese language journals and 6 English language journals), of which 802 were included in this synthesis. While 39.4% (n = 316) failed to report the GDM diagnostic criteria used, the remaining studies classified GDM with various international (n = 5) or Chinese (n = 7) diagnostic standards. Treatment interventions were categorized into 6 types: dietary (18.6%), exercise (1.6%), medication (20.7%), health education (9.0%), psychological (2.6%) and combination (47.4%). No interventions aimed at GDM prevention were identified. Meta-analyses demonstrated a statistically significant overall benefit of GDM treatment strategies in reducing the odds of maternal and infant adverse outcomes (ORs range 0.20–0.34, 95% CI 0.17–0.49, P < 0.05 for all). Dietary, western medication, and combined interventions were the most effective inteventions.ConclusionsAn increasing number of healthcare interventions were found in China aimed at controlling GDM while no interventions were intended for GDM prevention. Well-designed clinical trials are needed to determine the comparative and cost effectiveness of GDM prevention and treatment strategies.

Assessing medical professionalism: A systematic review of instruments and their measurement properties.

BackgroundOver the last three decades, various instruments were developed and employed to assess medical professionalism, but their measurement properties have yet to be fully evaluated. This study aimed to systematically evaluate these instruments’ measurement properties and the methodological quality of their related studies within a universally acceptable standardized framework and then provide corresponding recommendations.MethodsA systematic search of the electronic databases PubMed, Web of Science, and PsycINFO was conducted to collect studies published from 1990–2015. After screening titles, abstracts, and full texts for eligibility, the articles included in this study were classified according to their respective instrument’s usage. A two-phase assessment was conducted: 1) methodological quality was assessed by following the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist; and 2) the quality of measurement properties was assessed according to Terwee’s criteria. Results were integrated using best-evidence synthesis to look for recommendable instruments.ResultsAfter screening 2,959 records, 74 instruments from 80 existing studies were included. The overall methodological quality of these studies was unsatisfactory, with reasons including but not limited to unknown missing data, inadequate sample sizes, and vague hypotheses. Content validity, cross-cultural validity, and criterion validity were either unreported or negative ratings in most studies. Based on best-evidence synthesis, three instruments were recommended: Hisar’s instrument for nursing students, Nurse Practitioners’ Roles and Competencies Scale, and Perceived Faculty Competency Inventory.ConclusionAlthough instruments measuring medical professionalism are diverse, only a limited number of studies were methodologically sound. Future studies should give priority to systematically improving the performance of existing instruments and to longitudinal studies.

Secondary student achievement, particularly in science, related to school size, student socio-economic status, per pupil expenditures, student mobility rate, and percentage of non-white students: A modified best-evidence synthesis

The purpose of this study was to conduct a best evidence synthesis of secondary student achievement and science and as related to school size, student socio-economic status, per pupil expenditures, student mobility rate, and percentage of non-White students. Due to the lack of studies inclusive of any, a combination of, or all of those variables, we modified the best evidence process to include student achievement, encompassing of science as available, on standardized tests in U.S. schools. We determined this topic to be important for a number of reasons (a) the focus on science instruction over the years with changes in policies nationally and (b) the emphasis in Texas, in particular, on the biology exam which is a high stakes assessment (one of five exams needed to be passed in order to exit high school). In this paper, we share first the background of the study, the review methods, the results, and a discussion for further study.

Knee Extensor Strength and Risk of Structural, Symptomatic, and Functional Decline in Knee Osteoarthritis: A Systematic Review and Meta‐Analysis

To perform a systematic review and meta-analysis on the association between knee extensor strength and the risk of structural, symptomatic, or functional deterioration in individuals with or at risk of knee osteoarthritis (KOA). We systematically identified and methodologically appraised all longitudinal studies (≥1-year followup) reporting an association between knee extensor strength and structural (tibiofemoral, patellofemoral), symptomatic (self-reported, knee replacement), or functional (subjective, objective) decline in individuals with or at risk of radiographic or symptomatic KOA. Results were pooled for each of the above associations using meta-analysis, or if necessary, summarized according to a best-evidence synthesis. Fifteen studies were included, evaluating >8,000 participants (51% female), with a followup time between 1.5 and 8 years. Meta-analysis revealed that lower knee extensor strength was associated with an increased risk of symptomatic (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] pain: odds ratio [OR] 1.35, 95% confidence interval [95% CI] 1.10-1.67) and functional decline (WOMAC function: OR 1.38, 95% CI 1.00-1.89, and chair-stand task: OR 1.03, 95% CI 1.03-1.04), but not increased risk of radiographic tibiofemoral joint space narrowing (JSN) (OR 1.15, 95% CI 0.84-1.56). No trend in risk was observed for KOA status (present versus absent). Best-evidence synthesis showed inconclusive evidence for lower knee extensor strength being associated with increased risk of patellofemoral deterioration. Meta-analysis showed that lower knee extensor strength is associated with an increased risk of symptomatic and functional deterioration, but not tibiofemoral JSN. The risk of patellofemoral deterioration in the presence of knee extensor strength deficits is inconclusive.