Diverse Sources Of Evidence Research Articles

Dementia and Cognitive Decline: A HEALM Approach

Dementia and cognitive decline pose significant global public health challenges, with prevalence expected to rise in the coming decades. Lifestyle medicine offers a promising approach to mitigating cognitive issues through six key interventions: diet, physical activity, restorative sleep, social connections, stress management, and avoiding risky substances. Traditional methods like randomized controlled trials (RCTs) have limitations in capturing the long-term impacts of these interventions. To overcome these challenges, the American College of Lifestyle Medicine (ACLM) and the True Health Initiative (THI) developed the Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) framework, informed by the Evidence Threshold Pathway Mapping (ETPM) approach. This framework integrates diverse evidence sources to assess intervention effects over time. Applying HEALM, this review evaluates lifestyle factors’ impact on dementia and cognitive decline. It finds strong evidence supporting plant-based nutrition, physical activity, restorative sleep, and avoiding risky substances in promoting cognitive health. Social connections may mitigate cognitive decline, while stress management requires further investigation due to inconclusive findings. Integrating these findings into public health strategies could effectively address the growing dementia burden and enhance overall well-being in aging populations, underscoring the need for continued research in cognitive health.

Optimising digital clinical consultations in maternity care: a realist review and implementation principles.

The COVID-19 pandemic has led to increased use of digital clinical consultations (phone or video calls) within UK maternity services. This project aimed to review the evidence on digital clinical consultations in maternity systems to illuminate how, for whom and in what contexts, they can be used to support safe, personalised and equitable care. A realist synthesis, drawing on diverse sources of evidence (2010-present) from OECD countries, alongside insights from knowledge user groups (representing healthcare providers and service users). The review used three analytical processes (induction, abduction and retroduction) within three iterative stages (development of initial programme theories; evidence retrieval and synthesis; validation and refinement of the programme theories). Ninety-three evidence sources were included in the final synthesis. Fifteen programme theories were developed showing that digital clinical consultations involve different mechanisms operating across five key contexts: the organisation, healthcare providers, the clinical relationship, the reason for consultation and women. The review suggests that digital clinical consultations can be effective and acceptable to stakeholders if there is access to appropriate infrastructure/digital resources and if implementation is able to ensure personalisation, informed choice, professional autonomy and relationship-focused connections. The review found relatively less evidence in relation to safety and equity. Due to the complexity of maternity systems, there can be 'no one-size fits all' approach to digital clinical consultations. Nonetheless, the review distills four 'CORE' implementation principles: C-creating the right environment, infrastructure and support for staff; O-optimising consultations to be responsive, flexible and personalised to different needs and preferences; R-recognising the importance of access and inclusion; and E-enabling quality and safety through relationship-focused connections. Service innovation and research are needed to operationalise, explore and evaluate these principles, particularly in relation to safety and equity. CRD42021288702.

The role of general practitioners in the management of patients with acne using isotretinoin: Protocol for a scoping review of clinical practice guidelines

Background Acne is the most common inflammatory skin disease, affecting most teenagers and many adults. Acne imposes physical, psychological, social and fiscal burdens, with additional concerns around antimicrobial stewardship. Isotretinoin is the most effective treatment for severe acne. However, there are well-documented serious adverse effects with teratogenicity, impact on mental health and blood abnormalities of particular concern. The prescribing practice of isotretinoin varies substantially internationally. Some countries restrict isotretinoin prescribing solely to dermatologists, while other countries have guidance supporting GPs to prescribe isotretinoin as well. The existing literature lacks clarity around the important issue of who should prescribe isotretinoin and fails to describe the specific role of GPs in managing patients with acne using isotretinoin. This scoping review will address this evidence gap by examining the role of the GP in prescribing isotretinoin in acne clinical practice guidelines. Methods This scoping review adopts the Joanna Briggs Institute scoping review methodology with PRISMA extension for scoping reviews. The search strategy will interrogate medical databases and grey literature, and will also directly contact key stakeholders internationally, to identify clinical practice guidelines on the use of isotretinoin in acne from 2013 to May 2024. Two reviewers will independently review all citations, and full text of selected sources, against relevant inclusion-exclusion criteria. Appropriate data extraction tool(s) will be designed, piloted and refined, whereupon full data extraction will be undertaken. Results This scoping review will interrogate diverse evidence sources and distil the evidence base informing the role of GPs in prescribing isotretinoin for people with acne. Conclusion The strategic objective of this scoping review is to explore and illuminate the evidence around the role of GPs in prescribing isotretinoin when managing patients with acne.

Mapping complex public health problems with causal loop diagrams.

This paper presents causal loop diagrams (CLDs) as tools for studying complex public health problems like health inequality. These problems often involve feedback loops-a characteristic of complex systems not fully integrated into mainstream epidemiology. CLDs are conceptual models that visualize connections between system variables. They are commonly developed through literature reviews or participatory methods with stakeholder groups. These diagrams often uncover feedback loops among variables across scales (e.g. biological, psychological and social), facilitating cross-disciplinary insights. We illustrate their use through a case example involving the feedback loop between sleep problems and depressive symptoms. We outline a typical step-by-step process for developing CLDs in epidemiology. These steps are defining a specific problem, identifying the key system variables involved, mapping these variables and analysing the CLD to find new insights and possible intervention targets. Throughout this process, we suggest triangulating between diverse sources of evidence, including domain knowledge, scientific literature and empirical data. CLDs can also be evaluated to guide policy changes and future research by revealing knowledge gaps. Finally, CLDs may be iteratively refined as new evidence emerges. We advocate for more widespread use of complex systems tools, like CLDs, in epidemiology to better understand and address complex public health problems.

Methodological proposals for developing trustworthy recommendations of integrative Chinese-Western medicine

BackgroundTo refine the methods of developing clinical practice guidelines (CPGs) for integrative Chinese-Western medicine (ICWM), promoting the formation of trustworthy, implementable recommendations that integrate the strengths of Chinese and Western medicine. MethodsUsing a nominal group technique (NGT) approach, a multidisciplinary expert panel was established. The panel identified key methodological issues in ICWM-CPG development through literature review and iterative discussions, and formulated methodological proposals to address these issues. The final set of proposals was achieved through consensus among the panel members. ResultsThe collaborative effort resulted in the identification of five pivotal methodological issues and the subsequent establishment of 22 specific recommendations. These encompass strict adherence to renowned standards, such as those proposed by the Institute of Medicine (IOM) and Guidelines International Network (G-I-N), the employment of methodologies like the GRADE approach and RIGHT statement, the strategic constitution of a balanced development group, the adept identification of ICWM-focused clinical inquiries, the nuanced integration of diverse evidence sources, and the detailed crafting of transparent, implementable recommendations. ConclusionsThis study concentrates on the most crucial and prevalent methodological issues in ICWM-CPG development, proposing a series of recommendations. These suggestions result from a multidisciplinary expert consensus, aiming to provide methodological guidance for ICWM-CPG developers, building upon the current foundational methodologies.

How to Assess Oral Narrative Skills of Children and Adolescents with Intellectual Disabilities: A Systematic Review.

Children and adolescents with intellectual disabilities (ID) often encounter difficulties with narrative skills. Yet, there is a lack of research focusing on how to assess these skills in this population. This study offers an overview of the tools used for assessing oral narrative skills in children and adolescents with ID, addressing key questions about common assessment tools, their characteristics, and reported evidence. A systematic review was conducted of the literature published between 2010 and 2023 in the PsycINFO, ERIC, Education, and Psychology databases. An initial 1176 studies were reviewed by abstract, of which 485 were read in full text, leading to the selection and analysis of 22 studies. Most of the identified tools involve analyzing language samples obtained using wordless picture story books. Three common tools are emphasized. Studies have primarily identified inter-rater reliability and test-criterion evidence for validity. The main tools and their characteristics are discussed in depth to aid readers in discerning suitable options for research or practical applications. The importance of reporting diverse sources of evidence for validity and reliability within this population is highlighted.

Asset Based Community Development: Co-Designing an Asset-Based Evaluation Study for Community Research

This paper responds to challenges around how to generate robust evidence in keeping with the principles of an asset-based approach based on mobilization of community strengths. The design of a collaborative evaluation of a multi-site Asset Based Community Development program is described and emergent learning discussed. A qualitative mixed method design was used to capture changes at community and program level drawing on diverse sources of evidence. Shared principles on the conduct of the evaluation were developed with program leads and community practitioners and opportunities for shared learning were built in. The paper distils learning on evaluation into six design features including the asset-based model as a framework, understandings of evidence and outcomes, ethical conduct, and the centrality of a collaborative and developmental approach. The paper concludes that these features form a coherent approach to asset-based evaluation which can link the theory and practice of Asset Based Community Development.

Policy-oriented adaptation strategies for artisanal marine fisheries under climate and non-climate stressors in San Andres de Tumaco, Nariño, Colombia

Climate and non-climate stressors significantly impact artisanal fishing in San Andrés de Tumaco, Nariño, Colombia, a crucial activity for local food security and employment. Our study aimed to prioritize these stressors on artisanal Fisheries Economic Units (FEUs) and propose policy-oriented adaptation strategies. We adopted an integrated approach, using diverse evidence sources and techniques such as complex network theory and Multi-Criteria Decision Analysis. Key challenges identified include reduced fish catch, abnormal climatic conditions, and changes in fish distribution. The community prioritizes educational, counseling, cultural, and behavioral adaptation measures. Crucial policy-oriented strategies encompass researching fish species' vulnerability to climatic changes, predicting commercial fish distribution considering climatic shifts, and developing a WebGIS for accessible regional climatic information; strategies that are consequently aligned with the Integral Policy for the Development of Sustainable Fisheries in Colombia. Our integrated approach assists decision-making, fostering adaptive capacity within these communities. It underscores the need for policy-driven, locally-sensitive, and strategic action to ensure the long-term resilience of artisanal fisheries against climate change and non-climate stressors.

Health of Indigenous Orphans and Carers in Perú: A Mixed Methods Case Study of Hogar de Niñas Virgen de Fatima

The COVID-19 pandemic dealt a devastating blow to the social fabric of Perú, with the highest orphans per death (OPD) ratio of any country in Latin America. Therefore, 260,000 orphans now require care because of 216,000 parent, custodial grandparent, and caregiver deaths between 2020 and 2022. The purpose of this research is to examine whether the practice of Transcendental Meditation, an established technique for improving the mental and physical health of children, can reasonably be expected to alleviate the symptoms of trauma associated with this surge in orphanhood. Adolescent indigenous female orphans and their carers at Hogar de Niñas Virgen de Fatima de Chejoña, a residential care shelter near Puno in the country’s southeast, participated voluntarily in this mixed methods case study. Following a Type-2 case study structure, the research design details the context, case, embedded units of analysis, and methodological approaches used to measure them. Three research modules were designed to explore: 1) orphan and carer health, personal relations, behavior, sense of safety and security, and view of the future; 2) health and school performance of orphans; and 3) depression, anxiety, and stress of both orphans and carers. The mixed methods approach used to gather and interrogate data derived from these orphans and carers before and after instruction in Transcendental Meditation included: structured interviews to determine the direction before and after change (qualitative module one); a vernacular paper-and-pencil test to measure physical, cognitive, and emotional health and school performance after instruction (quantitative module two); and a standardized test instrument to measure depression, anxiety, and stress in orphans and carers after instruction (quantitative module three). Findings include self-report changes in orphans from feelings of fear, nervousness, and hopelessness to feelings of greater confidence, assurance, and a sense of achievement (module one); a significant difference between the number of orphans who reported improvements in health and school performance and those who did not receive Transcendental Meditation (module two); and higher levels of depression, anxiety, and stress in orphans than other comparative girls (module three). Despite limited carer data, the diverse sources of evidence for orphans, when considered in combination, suggest Transcendental Meditation may have salutarily improved both the present and future lives of girls in Perú.

Evidence inventory: A patient-centered framework for Centers for Medicare & Medicaid Services to assess the clinical benefit of drugs to inform its maximum fair price negotiation.

The Inflation Reduction Act passed in August 2022 empowers the Centers for Medicare & Medicaid Services (CMS) to negotiate maximum fair prices for certain expensive drugs. In the process of determining maximum fair prices, CMS gathers evidence on the clinical benefits of these drugs as compared with their therapeutic alternative(s) from various sources. As patients are the primary beneficiaries of the treatment, we recommend that CMS should embrace an approach that prioritizes patient experience when evaluating such diverse sources of evidence in the assessment of the clinical benefit. Thus, we propose to draw on several existing frameworks to support the concept of "evidence inventory," a patient-centered approach to systematically evaluate benefits of drugs under consideration. This 4-step process to develop an evidence inventory includes the following: (1) Formulate the research question-in a PICO(T) (P = population, I = Intervention or exposure, C = comparator, O = outcome, and T = time frame) format, (2) Synthesize evidence, (3) Evaluate the evidence-using evidence inventory, and (4) Reevaluate evidence as new information become available. Patients and other relevant stakeholders play a critical role in each of these 4 steps. The proposed evidence inventory holds the potential to provide a structured and transparent patient-centered framework for evaluating the clinical benefits of drugs as compared with their therapeutic alternative(s) informing CMS maximum fair price negotiation.

Estimating the Burden of Tuberculosis in India: A Modelling Study.

Measurements TB incidence and mortality are crucial for monitoring progress towards SDG goals for TB. Until recently, WHO estimated TB burden in India with applied simple, transparent equilibrium models to data from Gujarat, an Indian state where the first state-level prevalence survey was conducted in 2011. However, since then there has been several interventions in India including national TB prevalence survey, infection survey, sub-national survey & certification which gives opportunity for national and sub-national estimates for TB incidence and mortality. We developed a model is a compartmental, deterministic framework, taking account of TB natural history, as well as India's healthcare system including health care seeking from public and private sector. To address changes in TB burden owing to COVID disruptions, we followed same model that used by WHO in the global TB Report 2022 with additional impact of delta wave in 2021. Major sources of data included National TB Prevalence survey, trends in caseloads in public and private sector including their contribution and mortality information. We estimated total TB incidence of 2.77 million in the year 2022 as against 2.97 in the year 2015 and corresponding TB mortality of 0.32 and 0.36 million respectively. In terms of rate per 1,00,000 TB incidence in 2022 was 196 as compared to 225 in the year 2015 and mortality was 23 and 27 respectively. TB incidence estimates are similar to what was estimated by WHO, while mortality estimates appear different in our estimates due to different calibration targets depending on in-country published data. Even if TB burden is infeasible to measure directly, a range of data can nonetheless offer indirect evidence for its estimation: mathematical modelling can be a helpful tool for bringing together these diverse sources of evidence, and deriving estimates that are consistent with them all. While the RGI reported mortality is an important source of information, its quality and coverage for medically certified cause of deaths requires improvement in India.

Three Controversial Hypotheses Concerning Computation in the Primate Cortex

We consider three hypotheses concerning the primate neocortex which have influenced computational neuroscience in recent years. Is the mind modular in terms of its being profitably described as a collection of relatively independent functional units? Does the regular structure of the cortex imply a single algorithm at work, operating on many different inputs in parallel? Can the cognitive differences between humans and our closest primate relatives be explained in terms of a scalable cortical architecture? We bring to bear diverse sources of evidence to argue that the answers to each of these questions — with some judicious qualifications — are in the affirmative. In particular, we argue that while our higher cognitive functions may interact in a complicated fashion, many of the component functions operate through well-defined interfaces and, perhaps more important, are built on a neural substrate that scales easily under the control of a modular genetic architecture. Processing in the primary sensory cortices seem amenable to similar algorithmic principles, and, even for those cases where alternative principles are at play, the regular structure of cortex allows the same or greater advantages as the architecture scales. Similar genetic machinery to that used by nature to scale body plans has apparently been applied to scale cortical computations. The resulting replicated computing units can be used to build larger working memory and support deeper recursions needed to qualitatively improve our abilities to handle language, abstraction and social interaction.

Inflammation and Stroke Risk: A New Target for Prevention.

New therapeutic approaches are required for secondary prevention of residual vascular risk after stroke. Diverse sources of evidence support a causal role for inflammation in the pathogenesis of stroke. Randomized controlled trials of anti-inflammatory agents have reported benefit for secondary prevention in patients with coronary disease. We review the data from observational studies supporting a role for inflammation in pathogenesis of stroke, overview randomized controlled trials of anti-inflammatory therapy in cardiac disease and discuss the potential implications for stroke prevention therapy.

Mortality, migration and epidemiological change in English cities, 1600–1870

ObjectiveThis study tests the argument that industrialisation was accompanied by a dramatic worsening of urban health in England. MaterialsFamily reconstitutions derived from baptism, marriage and burial records for the period before 1837, and from civil registration of deaths and census populations between 1837 and 1900. MethodsAge-specific mortality rates are used as indicators of population health. ResultsThe available evidence indicates a decline in urban mortality in the period c.1750–1820, especially amongst infants and (probably) rural-urban migrants. Mortality at ages 1–4 years demonstrated a more complex pattern, falling between 1750 and 1830 before rising abruptly in the mid-nineteenth century. ConclusionsThese patterns are better explained by changes in breastfeeding practices and the prevalence or virulence of particular pathogens than by changes in sanitary conditions or poverty. Mortality patterns amongst young adult migrants were affected by a shift from acute to chronic infectious diseases over the period. SignificancePathogen evolution, infant care and migration exerted major influences on mortality trends and should be given greater attention in studies of the health impacts of British industrialisation. LimitationsEvidence of urban mortality rates is very limited before 1837 and may not be fully representative of industrialising populations. Mortality also provides only a partial picture of the health of urban populations and may be distorted by migration patterns. Further researchThere is enormous scope for collaboration between archaeologists and historians to investigate the health of industrial populations, through the triangulation and contextualisation of diverse sources of evidence.

Fragmentation in the future of work: A horizon scan examining the impact of the changing nature of work on workers experiencing vulnerability.

IntroductionThe future of work is characterized by changes that could disrupt all aspects of the nature and availability of work. Our study aims to understand how the future of work could result in conditions, which contribute to vulnerability for different groups of workers.MethodsA horizon scan was conducted to systematically identify and synthesize diverse sources of evidence, including academic and gray literature and resources shared over social media. Evidence was synthesized, and trend categories were developed through iterative discussions among the research team.ResultsNine trend categories were uncovered, which included the digital transformation of the economy, artificial intelligence (AI)/machine learning‐enhanced automation, AI‐enabled human resource management systems, skill requirements for the future of work; globalization 4.0, climate change and the green economy, Gen Zs and the work environment; populism and the future of work, and external shocks to accelerate the changing nature of work. The scan highlighted that some groups of workers may be more likely to experience conditions that contribute to vulnerability, including greater exposure to job displacement or wage depression. The future of work could also create opportunities for labor market engagement.ConclusionThe future of work represents an emerging public health concern. Exclusion from the future of work has the potential to widen existing social and health inequities. Thus, tailored supports that are resilient to changes in the nature and availability of work are required for workers facing vulnerability.

An international genome-wide meta-analysis of primary biliary cholangitis: Novel risk loci and candidate drugs

Backgrounds & AimsPrimary biliary cholangitis (PBC) is a chronic liver disease in which autoimmune destruction of the small intrahepatic bile ducts eventually leads to cirrhosis. Many patients have inadequate response to licensed medications, motivating the search for novel therapies. Previous genome-wide association studies (GWAS) and meta-analyses (GWMA) of PBC have identified numerous risk loci for this condition, providing insight into its aetiology. We undertook the largest GWMA of PBC to date, aiming to identify additional risk loci and prioritise candidate genes for in silico drug efficacy screening.MethodsWe combined new and existing genotype data for 10,516 cases and 20,772 controls from 5 European and 2 East Asian cohorts.ResultsWe identified 56 genome-wide significant loci (20 novel) including 46 in European, 13 in Asian, and 41 in combined cohorts; and a 57th genome-wide significant locus (also novel) in conditional analysis of the European cohorts. Candidate genes at newly identified loci include FCRL3, INAVA, PRDM1, IRF7, CCR6, CD226, and IL12RB1, which each play key roles in immunity. Pathway analysis reiterated the likely importance of pattern recognition receptor and TNF signalling, JAK-STAT signalling, and differentiation of T helper (TH)1 and TH17 cells in the pathogenesis of this disease. Drug efficacy screening identified several medications predicted to be therapeutic in PBC, some of which are well-established in the treatment of other autoimmune disorders.ConclusionsThis study has identified additional risk loci for PBC, provided a hierarchy of agents that could be trialled in this condition, and emphasised the value of genetic and genomic approaches to drug discovery in complex disorders.Lay summaryPrimary biliary cholangitis (PBC) is a chronic liver disease that eventually leads to cirrhosis. In this study, we analysed genetic information from 10,516 people with PBC and 20,772 healthy individuals recruited in Canada, China, Italy, Japan, the UK, or the USA. We identified several genetic regions associated with PBC. Each of these regions contains several genes. For each region, we used diverse sources of evidence to help us choose the gene most likely to be involved in causing PBC. We used these ‘candidate genes’ to help us identify medications that are currently used for treatment of other conditions, which might also be useful for treatment of PBC.

Bringing evidence to bear for negotiating tradeoffs in sustainable agricultural intensification using a structured stakeholder engagement process

ABSTRACT Sustainable agricultural intensification (SAI) has the potential to increase food security without detrimental effects on ecosystem services. However, adoption of SAI practices across sub-Saharan Africa has not reached transformational numbers to date. It is often hampered by lack of context-specific practices, sub-optimal understanding of tradeoffs and synergies among stakeholders, and lack of approaches that bring diverse evidence sources together with stakeholders to collectively tackle complex problems. In this study, we asked three interconnected questions: (i) What is the accessibility and use of evidence for SAI decision making; (ii) What tools could enhance access and interaction with evidence for tradeoff analysis; and (iii) Which stakeholders must be included? This study employed a range of research and engagement methods including surveys, stakeholder analysis, participatory trade-off assessments and co-design of decision dashboards to better support evidence-based decision making in Zambia, Tanzania and Ethiopia. At the inception, SAI evidence was accessible and used by less than half of the decision makers across the three countries and online dashboards hold promise to enhance access. Many of the stakeholders working on SAI were not collaborating and tradeoff analysis was an under-utilized tool. Structured engagement across multiple stakeholder groups with evidence is critical.

Culturally diverse expert teams have yet to bring comprehensive linguistic diversity to intergovernmental ecosystem assessments

Culturally diverse expert teams have yet to bring comprehensive linguistic diversity to intergovernmental ecosystem assessments

Metaphors in the Making: Illuminating the Process of Arts-Based Health Research Through a Case Exemplar Linking Arts-Based, Qualitative and Quantitative Research Data

Background: The potentials of arts-based health research are increasingly being realized as an approach to understanding and communicating the complexities of the human experience of health and illness. Despite this, arts-based health research often remains shrouded in obscurity, limiting its potential utility. Arts-based health research offers unique opportunities to integrate evidence of patients’ lived experience with other forms of research evidence to improve understanding and knowledge translation, but transparent descriptions of this praxis are generally lacking. In response, this article offers methodological insight and guidance through an in-depth case exemplar of an arts-based health research process linking qualitative research with diverse evidence sources in the context of frailty research. Methods: Responding to research data generated within a Centre of Research Excellence in Frailty and Healthy Ageing, we adopted a researcher-as-practitioner stance to produce research-based artworks to integrate and communicate conflicting research findings. We structure this process according to Ecker’s seven domains of qualitative inquiry, demonstrating parallels between the arts-based research and qualitative inquiry processes and offering opportunities for engaging with “evidence misalignments” resulting from incongruent evidence sources. Findings: Arts-based health research can enable meaningful reflection upon, integration, and communication of “evidence-misalignments” in research spanning the health and social sciences. Such misalignments are problematic when the lived experience of health and illness conflicts with other empirical evidence, including gold standard evidence guiding treatment decisions. These in turn, can function as plausible barriers to self management and to achievement of health outcomes. Interpretation: Through the researcher-as-practitioner lens, and with an orientation to production, this work engaged with a new means of materiality—one that extends beyond text and numerical representations—and whose meaning and connections may not be immediately apparent. These relationships change how the researchers-practitioner engages with, understands, explores, and represents concepts, enabling epistemological and ontological gains of benefit to the health and social sciences.

The effect direction plot revisited: Application of the 2019 Cochrane Handbook guidance on alternative synthesis methods.

Effect direction (evidence to indicate improvement, deterioration, or no change in an outcome) can be used as a standardized metric which enables the synthesis of diverse effect measures in systematic reviews. The effect direction (ED) plot was developed to support the synthesis and visualization of effect direction data. Methods for the ED plot require updating in light of new Cochrane guidance on alternative synthesis methods. To update the ED plot, statistical significance was removed from the algorithm for within‐study synthesis and use of a sign test was considered to examine whether patterns of ED across studies could be due to chance alone. The revised methods were applied to an existing Cochrane review of the health impacts of housing improvements. The revised ED plot provides a method of data visualization in synthesis without meta‐analysis that incorporates information about study characteristics and study quality, using ED as a common metric, without relying on statistical significance to combine outcomes of single studies. The results of sign tests, when appropriate, suggest caution in over‐interpreting apparent patterns in effect direction, especially when the number of included studies is small. The revised ED plot meets the need for alternative methods of synthesis and data visualization when meta‐analysis is not possible, enabling a transparent link between the data and conclusions of a systematic review. ED plots may be particularly useful in reviews that incorporate nonrandomized studies, complex systems approaches, and diverse sources of evidence, due to the variety of study designs and outcomes in such reviews.