Evidence-based Appraisal Research Articles

An evidence-based assessment of the nutritional recommendations for thepreventionof diabetes mellitus.

Thissystematic review presents the most recent scientific knowledge concerningdietary recommendations for T2DM published in the English language by various scientific societies during the past 10years. The recommendations are herein presented and discussed in the light of a critical, evidence-based appraisal aiming to provide a comprehensive guide for the clinician in daily practice. In the case of overweight or obesity, the cornerstone of the primary prevention of T2DM is the combination of a healthy body weight (body mass index < 25kg/m2) or a reduction of fat byat least 7% and the implementation of at least 150min of moderate physical activity per week. Restriction of calories and of dietary fat is recommended, the latter as well as several dietary patterns providing a holistic approach to dieting andall havingbeen correlated with decreased risk of T2DM. Among these dietary patterns are the Mediterranean diet, the DASH diet (Dietary Approaches to Stop Hypertension), the low-glycemic diet, and the HEI-Healthy Eating Index and AHEI-Alternative Healthy Eating Index. Micronutrient deficiencies of, for example, vitamin D, chromium and magnesium, may be associated with insulin resistance in T2DM. Overall, the combination of nutrition through dietary patterns that are mainly plant-based and which emphasize wholegrains, legumes, nuts, fruits, and vegetables and that include only small percentages of refined and processed foods, together with physical activity, has been associated with decreased T2DM risk.

Systematic review and meta-analysis of developmental assets scales: A study protocol for psychometric properties.

Application of developmental assets, one of existing Positive Youth Development (PYD) frameworks, has gained momentum in research, policy formulations, and interventions, necessitating the introduction of the most efficient scales for this framework. The present study protocol aims to conduct a systematic review and meta-analysis of developmental assets scales to document the underlying logic, objectives, and methodologies earmarked for the identification, selection, and critical evaluation of these scales. In accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P), the intended search will encompass databases of PubMed, Scopus, Web of Knowledge, and PsycINFO, spanning from the inception of 1988 to 1st of April 2024. The review will include articles published published in English language focusing on individuals aged 10 to 29 years and reporting at least one type of reliability or validity of developmental assets scales. The review process will be in compliance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN), and the overall quality of evidence will be determined using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. This comprehensive assessment aims to identify potential biases in prior research and offer guidance to scholars regarding the optimal scales for developmental assets in terms of validity, reliability, responsiveness, and interpretability The evidence-based appraisal of the scales strengths and limitations is imperative in shaping future research, enhancing their methodological rigor, and proposing refinements to existing instruments for developmental assets.

Where Does Lamotrigine Fit in the Pharmacotherapy of Mood Disorders? An Evidence-Based Appraisal.

Where Does Lamotrigine Fit in the Pharmacotherapy of Mood Disorders? An Evidence-Based Appraisal.

Zhishi Xiebai Guizhi Decoction for coronary heart disease: A systematic review and meta-analysis.

Coronary heart disease (CHD) is a type of cardiovascular disease (CVD) caused by coronary atherosclerosis. It is a main cause of medical burden and cardiovascular related death. Zhishi Xiebai Guizhi Decoction (ZXGD) is a representative prescription of traditional Chinese medicine (TCM) in the treatment of CHD, but there is poor systemically evidence-based appraisal. To evaluate the efficacy and safety of ZXGD for CHD. Eight databases were retrieved for randomized controlled trials (RCTs). Data was extracted independently by 2 reviewers. The quality of the included studies was assessed by Cochrane Collaboration risk of bias tool. Clinical efficacy, blood lipid, vascular endothelial function, inflammatory factor and homocysteine (Hcy) were prespecified outcome measures. Twenty-four studies (2272 patients) were included. Meta-analysis showed that compared with conventional western medicine (WM) alone, ZXGD was associated with a greater symptom improvement rate with a relative risk (RR) of 1.21 [95% CI (1.16, 1.26), P < .00001] and a greater electrocardiogram (ECG) improvement rate with a RR of 1.27 [95% CI (1.16, 1.40), P < .00001]. In terms of blood lipid, ZXGD reduced total cholesterol (TC) with a mean difference (MD) of -1.15 [95%CI (-1.75, -0.55), P = .0002] and triglyceride (TG) [MD = -0.72, 95%CI (-0.99, -0.45), P < .00001], reduced low-density lipoprotein cholesterol (LDL-C) [MD = -0.93, 95% CI (-1.17, -0.69), P < .00001], and increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.31, 95%CI (0.20, 0.42), P < .00001]. In terms of vascular endothelial function, ZXGD decreased the level of endothelin-1 (ET-1) [MD = -7.81, 95%CI (-9.51, -6.10), P < .00001], and increased nitric oxide (NO) [MD = 8.90, 95%CI (7.86, 9.93), P < .00001]. ZXGD also reduced high-sensitivity C-reactive protein (hs-CRP) [MD = -1.73, 95% CI (-2.63, -0.83), P < .00001] and Hcy [MD = -2.03, 95%CI (-2.78, -1.28), P < .00001]. No significant differences were found in adverse event rate between the 2 groups with a RR of 0.77 [95% CI (0.44, 1.34), P = .36]. ZXGD is effective and safe in the treatment of CHD. However, more rigorous and high-quality RCTs are needed to verify the conclusion.

Understanding the public voices and researchers speaking into the 5G narrative.

The many different voices speaking into the current narrative surrounding the health effects of 5G technologies necessitate an exploration of the background of the various published author-spokespersons and their potential motives. This has been attempted recently by de Vocht and Albers. However, that opinion piece used a narrow investigative lens, resulting in an undermining of both the rationality of the concerned general public and the motives of specific researchers. At the same time, biases, conflicts of interest, and flaws found in "independent" reviews were not considered. To address these oversights, an evidence-based appraisal of public opinion and the scientific caliber of authors involved in the 5G health discussion is warranted. Subsequently, this review article presents an analysis of the available Australian data representing public voices, while also conducting a broader investigation of the level of expertise of recent author-spokespersons based on their experience as scientists, particularly in the area of health effects of radiofrequency electromagnetic fields. This review thus attempts to more clearly illustrate for the reader the caliber and motives of the voices speaking into the 5G narrative. The article concludes with a set of questions that need to be answered to enable scientists to advise policy makers more effectively on matters of 5G and public health.

Evidence-based appraisal of the role of SJTs in selection

A recent opinion article in Clinical Medicine promoted a new preference-based algorithm to allocate training places for the UK Foundation Programme Office (UKFPO). This replaced the previous process, which ranked candidates based on medical school academic achievement (the educational performance measure; EPM) and the score on a situational judgement test (SJT). Although not without risks, we believe that the new system has positive potential. In presenting their case, Sam et al summarised evidence relating to the UKFPO in an unbalanced way, leading to what we believe are erroneous inferences, particularly with regard to differential attainment. Here, we provide an example of how the general evidence base and conceptual understanding of the validity of SJTs for medical selection is poorly understood. We highlight important research findings that were not cited by Sam et al and provide what we believe is a more balanced and accurate interpretation of the evidence base relating the UKFPO SJT, and SJTs used in medical selection in general. We do this with particular reference to the validity of such tools in this context, as well as their potential impact on under-represented groups in medicine, compared with other selection assessments.

Evidence-based appraisal of two guidelines for the diagnosis of suspected, uncomplicated urinary tract infections in primary care: a diagnostic accuracy validation study.

Given the lack of accurate rapid diagnostics for urinary tract infection (UTI) in women, many countries have developed guidelines aiming to support appropriate antibiotic prescribing, but some guidelines have not been validated. We performed a diagnostic accuracy validation study of two guidelines: Public Health England (GW-1263) and Scottish Intercollegiate Guidelines Network (SIGN160). We used data from women with symptoms suggestive of uncomplicated UTI from a randomized controlled trial comparing urine collection devices. Symptom information was recorded via baseline questionnaire and primary care assessment. Women provided urine samples for dipstick testing and culture. We calculated the number within each risk category of diagnostic flowcharts who had positive/mixed growth/no significant growth urine culture. Results were presented as positive/negative predictive values, with 95% CIs. Of women aged under 65 years, 311/509 (61.1%, 95% CI 56.7%-65.3%) classified to the highest risk category (recommended to consider immediate antibiotic prescribing) and 80/199 (40.2%, 95% CI 33.4%-47.4%) classified to the lowest risk category (recommended to reassure that UTI is less likely) by the GW-1263 guideline (n = 810) had positive culture. For the SIGN160 guideline (n = 814), the proportion with positive culture ranged from 60/82 (73.2%, 95% CI 62.1%-82.1%) in those for whom immediate treatment was indicated to 33/76 (43.4%, 95% CI 32.3%-55.3%) in those recommended a self-care/waiting strategy. Clinicians should be aware of the potential for diagnostic error when using diagnostic guidelines for managing uncomplicated UTI and making antimicrobial prescribing decisions. Infection cannot be excluded on the basis of symptoms and dipstick testing alone.

Key questions for the evaluation of anti-amyloid immunotherapies for Alzheimer's disease.

The clinical benefit associated with anti-amyloid immunotherapies, a new class of drugs for the treatment of Alzheimer's disease, is predicated on their ability to modify disease course by lowering brain amyloid levels. At the time of writing, two amyloid-lowering antibodies, aducanumab and lecanemab, have obtained United States Food and Drug Administration accelerated approval, with further agents of this class in the Alzheimer's disease treatment pipeline. Based on limited published clinical trial data to date, regulators, payors and physicians will need to assess their efficacy, clinical effectiveness and safety, as well as cost and accessibility. We propose that attention to three important questions related to treatment efficacy, clinical effectiveness and safety should guide evidence-based consideration of this important class of drugs. These are: (1) Were trial statistical analyses appropriate and did they convincingly support claims of efficacy? (2) Do reported treatment effects outweigh safety concerns and are they generalizable to a representative clinical population of people with Alzheimer's disease? and (3) Do the data convincingly demonstrate disease course modification, suggesting that increasing clinical benefits beyond the duration of the trials are likely? We suggest specific approaches to interpreting trial results for these drugs and highlight important areas of uncertainty where additional data and a cautious interpretation of existing results is warranted. Safe, effective and accessible treatments for Alzheimer's disease are eagerly awaited by millions of patients and their caregivers worldwide. While amyloid-targeting immunotherapies may be promising disease-modifying Alzheimer's disease treatments, rigorous and unbiased assessment of clinical trial data is critical to regulatory decision-making and subsequently determining their provision and utility in routine clinical practice. Our recommendations provide a framework for evidence-based appraisal of these drugs by regulators, payors, physicians and patients.

Prophylactic aspects and therapeutic potential of Turbud (Operculina turpethum L) in Unani medicine: An evidence-based appraisal

Abstract &#x0D; Turbud (Operculina turpethum L.) belongs to the family Convolvulaceae, a potent and well-known medicinal herb, used in Unani system of medicine to treat several diseases. It is a large perennial twinner with milky juice. Roots are long, slender, fleshy, and much branched. In classical text it is mentioned that the Turbud which is white in colour, light weighted and having resin on both ends is of good quality. In Unani system of medicine, its main actions are expectorant and laxative and used in several diseases like arthritis, ascites, gout, hemiplegia etc. According to Ibn Sina use of Turbud along with zanjabeel is more effective. It has been used as an important component in many compound formulations such as Itrifal Ustu-khud’dus, Itrifal Zamani, Itrifal Muqil, Itrifal Mulaiyyin. The major chemical constituents present are turpethin, glucoside, jalapine, convolvulin etc. Operculina turpethum L. is validated for its different pharmacological actions like anti-inflammatory effect, and ulcer protective etc. The present review comprehensively embodied its phytochemical, pharmacological and pharmacognostic description.

A freshwater perspective on the United Nations decade for ecosystem restoration

AbstractGlobally, ecosystems have suffered from anthropogenic stressors as we enter the sixth mass extinction within the Anthropocene. In response, the UN has declared 2020–2030 the Decade for Ecosystem Restoration, aiming to mitigate ecosystem degradation and biodiversity loss. Freshwater ecosystems are disproportionately impacted relative to marine or terrestrial systems and ecological restoration is needed to preserve biodiversity and ecosystem services. Paradoxically, freshwater is among Earth's most vital ecosystem services. Here we identify meaningful considerations from a freshwater perspective that will lead to progression toward the restoration of freshwater ecosystems: work across terrestrial and freshwater boundaries during restoration, emulate nature, think and act on a watershed scale, design for environmental heterogeneity, mitigate threats alongside restoration, identify bright spots, think long term (a decade is not long enough), and embrace social–ecological systems thinking. Further, we reflect upon the three implementation pathways identified by the UN to translate these considerations into practice in hopes of “bending the curve” for freshwater biodiversity and ecosystems. Pathway 1, building a global movement, could create a network to share experiences and knowledge promoting vicarious learning, ultimately leading to more effective restoration. Pathway 2, generating political support, will be necessary to institutionalize ecosystem protection and restoration by demonstrating the value of freshwater ecosystems and biodiversity. Pathway 3, building technical capacity, aims to improve the current and often ineffective restoration toolbox by incorporating evidence syntheses (i.e., appraisal of evidence base) and Indigenous ways of knowing (i.e., two eyed seeing). Given that freshwater ecosystems are in dire need of repair, it is our hope that these considerations and implementation pathways will contribute to an actionable and productive Decade for Ecosystem Restoration.

The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve

Patients who need a prosthetic aortic heart valve may decide, working with their cardiologist and cardiac surgeon, among a variety of options: surgical or transcatheter approach, bioprosthetic or mechanical valve, or a Ross procedure if suitable to their age and anatomy. This review article examines the evidence for survival benefit with mechanical aortic valves, discusses bioprosthetic structural valve degeneration and its consequences, and considers the risks of redo aortic valve surgery or subsequent valve-in-valve (ViV) transcatheter intervention. It highlights the unique characteristics of the On-X aortic valve, including the US Food and Drug Administration approved and American College of Cardiology/American Heart Association guideline supported reduced anticoagulation target INR of 1.5 to 2.0, and discusses the PROACT Xa trial comparing apixaban vs warfarin anticoagulation. The choice of prosthetic valve should be individualized, carefully considering each patient's unique circumstances. In that context, the On-X aortic valve offers a potential lifetime solution without need for a repeat operation, while minimizing the risks of long-term anticoagulation. In an era of enthusiasm for bioprosthetic and transcatheter-based approaches, the option of a second-generation bileaflet mechanical valve with optimized hemodynamics—the On-X aortic valve—may well align with patient expectations.

Sailing through the COVID-19 Pandemic and Beyond: An Evidence-Based Analysis for Dental Healthcare and Practice.

This integrative review aims to provide a consolidated evidence-based appraisal of the most up-to-date guidelines and recommendations of international public and professional health regulatory bodies in relation to preparedness framework for restructuring safe delivery of dental services amid and beyond the coronavirus disease-2019 (COVID-19) pandemic. Most recent updated guidelines for dental professionals from major international health regulatory bodies were reviewed. PubMed, Google Scholar, Cochrane Central Register of Controlled Trials, WHO COVID-19 and LILACS databases, along with relevant preprints were searched, and citations were checked up to January 23, 2021. The search was performed by one author. Shortlisted articles were read and brought to consensus to be included in the study by at least two co-authors. In case of any disagreement between the judgements, an independent co-author’s decision was taken as final. Of 849 records searched, 61 articles were included in the study. Following content analysis of the global guidelines and the collected prevailing evidence, the common themes and recommendations of different guidance documents were collated and summarized into seven domains. Most guidelines have a consensus regarding implementation of rigorous administrative, engineering and environmental infection control strategies. However, variations do exist with regard to the use of respirators in non-aerosol-generating procedure (non-AGP) settings, employment of airborne precautions during non-AGPs, use of supplemental air-handling systems, and preoperative use of mouthwashes. This evidence-based analysis can serve as a useful reopening resource tool and facilitate effective restructuring for delivery of optimal, equitable and safe dental practices globally, during and while emerging from the pandemic.

Can The 'Speed Bump Sign' Be a Diagnostic Tool for Acute Appendicitis? Evidence-Based Appraisal by Meta-Analysis and GRADE.

Objectives: The ‘speed bump sign’ is a clinical symptom characterised by aggravated abdominal pain while driving over speed bumps. This study aimed to perform a diagnostic meta-analysis, rate the certainty of evidence (CoE) and analyse the applicability of the speed bump sign in the diagnosis of acute appendicitis. Materials and Methods: Four databanks and websites were systemically searched, and the Quality Assessment of Diagnostic Accuracy Studies 2 was used to evaluate the risk of bias. Meta-analysis was assessed by MIDAS commands in Stata 15. Grading of Recommendations, Assessment, Development and Evaluation methodology was applied to examine the CoE. Results: Four studies with 343 participants were included. The pooled sensitivity and specificity were 0.94 (95% CI (confidence interval) = 0.83–0.98; I2 = 79%) and 0.49 (95% CI = 0.33–0.66; I2 = 67%), respectively. The area under the summary receiver operating characteristic curve was 0.78 (95% CI = 0.74–0.81). The diagnostic odds ratio was 14.1 (95% CI = 3.6–55.7). The pooled positive and negative likelihood ratios (LR (+) and LR (−)) were 1.84 (95% CI = 1.30–2.61) and 0.13 (95% CI = 0.04–0.41), respectively. According to Fagan’s nomogram plot, when the pretest probabilities were 25%, 50% and 75%, the related posttest probabilities increased to 38%, 65% and 85% calculated through LR (+), respectively, and the posttest probabilities were 4%, 12% and 28% calculated through LR (−), respectively. The overall CoEs were low and very low in sensitivity and specificity, respectively. Conclusion: Current evidence shows that the speed bump sign is a useful ‘rule-out’ test for diagnosing acute appendicitis. With good accessibility, the speed bump sign may be added as a routine part of taking the history of patients with abdominal pain.

COMMENT: Ayurveda awaits a new dawn.

Ayurveda is a valuable legacy bequeathed to us by ancient Indian sage-physicians. The present paper discusses the epistemology of this ancient science and the misconceptions surrounding it. Diligent research, both theoretical and experimental, in the twentieth century could have ensured the graduation of this proto-science into a full-fledged science. Instead, epistemological misconceptions and intellectual sloth have thwarted its refinement and progress. The paper appeals for an epistemological break that would facilitate an evidence-based appraisal of Ayurveda's theories and practices. Such an appraisal would help realise Ayurveda's full potential in serving India's healthcare needs, especially at the level of primary care.

Clinical Competency: Simulation Compared with Lectures in Training Registered General Nursing (RGN) at Time of Completion of Program—A Systematic Review

Background: Advancing the science of nursing education through technology into teaching and learning is essential to prepare nurses for the changing healthcare environment. Objective: To synthesise evidence in nursing students’ competency in the clinical setting immediately after completion of training with simulation compared with lectures. Methods: Databases were sourced electronically from CINAHL and PubMed using keywords Simulation, lecture, clinical competency and new graduates. Study Eligibility Criteria, Participants and Interventions: Published articles addressing the research objectives, written in English, spaning between September 2010 and March 2019 directly answer the PSCOT question with results applicable to the population specific-nursing students, simulation was utilized. Study Appraisal and Synthesis Methods: Extracted data from sorted studies were analysed and assessed for quality using the John Hopkins Evidence-Based Appraisal Tools. Results: The two-database yielded 520 articles, 10 met the eligibility criteria. Findings documented three important themes: 1) Clinical competence among nurses; 2) Medical residents’ clinical competence and 3) Was about the competence of anaesthesiology residents. Limitations: The identified studies used small sample sizes ranging from 20 to 98 participants in the single research studies. Conclusions: The review of the literature found that the active teaching strategy of simulation was more effective in promoting clinical competency in nursing students compared with the lecture method. The evidence-based teaching project proposes the use of simulation as the primary teaching method to improve the clinical competency abilities of registered general nursing (RGN) diploma students.

Disability Self-evaluation for Low Back Pain in COVID-19 Pandemic

ABSTRACTIntroduction: Low back pain (LBP) interferes with daily activities, which is why monitoring of functional disability is important. Non-urgent hospital visits are reduced due to the COVID-19 pandemic. Functional disability questionnaires serve as an alternative fo r patients to self-monitor their condition.Methods: This case-based study aimed to compare the Quebec Back Pain Disability Scale (QBPDS) with the Oswestry Disability Index (ODI) on their responsiveness in assessing functional disability of patients with LBP. Four databases (PubMed, Scopus, Cochrane, and Embase) were searched for literature. Two eligible studies were included in this report. The studies were assessed using the Centre for Evidence-Based Medicine critical appraisal tool for diagnostic studies. Data collected on the responsiveness of ODI and QBPDS were measured using the area under the curve (AUC) of a receiver operating curve (ROC), sensitivity, and specificity.Result: Both studies reported higher AUC values for ODI than QBPDS. One study reported higher sensitivity in ODI and identical specificity values for both ODI and QBPDS. QBPDS has comparable responsiveness to ODI in assessing functional disability of pat ients with LBP.Conclusion: Therefore, patients with low back pain can self-monitor their condition with QPBDS, as it is comparable to ODI and suitable for self-monitor during the C OVID-19 pandemicKeywords: assessment, disability evaluation, low back pain, musculoskeletal pain, surveys andquestionnaires

Evidence-based Appraisal of the CARAVAGGIO Trial

Evidence-based Appraisal of the CARAVAGGIO Trial

Evidence-based Appraisal of the RECOVERY Trial

Evidence-based Appraisal of the RECOVERY Trial

Incidence, Diagnosis, and Management of Neuromas Following Radiofrequency Ablation Treatment: a Narrative Review.

To determine the epidemiology of neuroma formation as a complication following radiofrequency ablation for chronic pain conditions as well as reviewing the diagnosis and management of neuromas. Evidence-based narrative review and critical appraisal of literature. A comprehensive review of the literature generated one case report describing neuroma formation following lumbar facet medial branch radiofrequency denervation. The rare incidence may be explained by neuroma pathophysiology and peripheral nerve injury produced by radiofrequency ablation, in combination with its asymptomatic nature. Diagnosis of neuromas is predominantly confirmed by clinical history and physical exam with potential for nerve blocks or imaging. Ultrasound has been suggested as a primary imaging modality with magnetic resonance imaging as a secondary option. Neuroma management ranges from conservative therapy to surgery with varying success rates. Neuroma formation following radiofrequency ablation procedures is exceedingly rare and could be a hypothetical concern in clinical practice. However, the true incidence may be inaccurate given the asymptomatic nature of neuromas.

Tablet-Based Apps for Phonics and Phonological Awareness: Protocol for Evidence-Based Appraisal of Content, Quality, and Usability.

BackgroundThe use of mobile apps to manage and promote health is becoming increasingly popular. Mobile apps are gaining popularity particularly in educational and interventional settings owing to their perceived advantages including support for and engagement of individuals with reading difficulties. In the context of COVID-19, the need for technology-based tools has increased. For practitioners and educators who wish to use apps in their practice or recommend apps to individuals with reading difficulties, it is challenging to identify high-quality apps in app stores.ObjectiveThis protocol describes a systematic search, selection, and appraisal process for tablet apps targeting phonics knowledge and phonological awareness skills. This protocol aimed to (1) provide a systematic method for identifying tablet apps targeting phonics knowledge and phonological awareness skills in the Google Play Store and Apple’s App Store and (2) describe an evidence-based approach for quality appraisal of these apps by using structured tools.MethodsThis protocol describes an evidence-based method guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework to systematically search, select, and appraise apps targeting phonics knowledge and phonological awareness skills, present in Google Play and the App Store. We intend to perform a systematic and comprehensive search and a 2-step process for screening: (1) broad screening (app titles) and (2) narrow screening (marketing descriptions). Quality appraisal of the included apps will involve two structured appraisal tools: (1) the Mobile Application Rating Scale and (2) the Appraising Apps for Reading Checklist.ResultsThis method will help determine the number of apps targeting phonics knowledge and phonological awareness, present on the Android and iOS platforms. The content, quality, and usability of these apps will be determined using structured appraisal tools. We have planned to conduct searches on Google Play and the App Store in January-March 2021; broad and focused screening, from April 2021; and data extraction and quality appraisal in October 2021.ConclusionsThis protocol provides a basis for locating and evaluating apps targeting phonics knowledge and phonological awareness skills. This protocol will support practitioners, educators, and families to make informed decisions when purchasing apps for instructional use.International Registered Report Identifier (IRRID)PRR1-10.2196/23921