Evidence-based Assessment Research Articles

Toward a data-informed framework for the assessment of digital readiness of higher education institutions

AbstractThis paper aims to address Digital Readiness in Higher Education Institutions from the perspective of data-informed and evidence-based assessment of Digital Readiness. Related research suggests that existing instruments for assessing digitalization aspects are limited to self-assessment, and there is a need for data-informed frameworks that will allow automated assessments based on data that Higher Education Institutions already collect. To bridge this gap, we propose a conceptual, data-informed framework for assessing Digital Readiness in Higher Education Institutions. We followed a participatory approach informed by related theory and practice to design, together with stakeholders from three academic institutions in three European countries, a Digital Readiness assessment framework on seven dimensions accompanied by 72 data-informed indicators. Digitalization of Higher Education is a priority in political agendas, and educational institutions have acknowledged it as an opportunity to promote digitalization of teaching and learning, organizational structures, and technical services, enabling innovation and internationalization. We envision that this work contributes towards supporting educational institutions in self-reflecting upon their digitalization policies and practices.

Validity of data extraction in acupuncture meta-analysis: a reproducibility study protocol

IntroductionSystematic review and meta-analysis occupy the apex of the evidence pyramid, serving as the most comprehensive and reliable form of evidence-based assessment. Data extraction is a crucial juncture in meta-analysis,...

A dedicated wound care module for third-year baccalaureate nurses: does it increase their knowledge and confidence?

Wound care is an important component of nursing care, consuming a significant amount of working hours. Literature reports the existence of many barriers to evidence-based wound care and that nursing students have an increasing need for education in this field. While blended learning activities have shown some benefits in learning outcomes, dedicated wound care modules within baccalaureate nursing courses occur infrequently. The aim of this study was to facilitate an increase in confidence and knowledge of evidence-based wound care in third-year baccalaureate nursing students. In this descriptive pre-post research design, a dedicated wound care module within a baccalaureate nursing course (using a constructivist learning approach) was offered to students in a university in Australia. Pre- and post-implementation surveys were completed (2018-2020). Due to a small number of matching participants, only descriptive statistics were calculated for all variables. A total of 276 students were invited to respond to the survey and 41 responded initially, 35 responded post the wound care module, and 26 responded to the survey after six months. Positive outcomes were noted in increased levels of confidence in the student nurses' ability to assess, manage and prevent wounds; as well as to apply evidence-based practice and change management following the educational wound care module within the baccalaureate nursing course. Implementation of a dedicated wound care module within a baccalaureate nursing course in this sample of third-year students fostered a positive change in the knowledge of evidence-based wound management, assessment and prevention. Education of the next generation of registered nurses in this valuable area of practice is an important part of baccalaureate nursing education.

Intensity or Duration: That Is the Main Question of the Exercise Training Management in Stroke-Induced Neurological Deficit - A Systematic and Meta-analysis Study

Background: The neurological assessment plays a crucial role in evaluating stroke patients and is a skill that has been practiced by physicians for a long time, and further refined by practitioners. The purpose of the current study was to systematically review and synthesize the evidence-based neurological assessment of the different methods of treadmill-related training protocols in stroke patients. Evidence Acquisition: In this study, the appropriate studies were documented (N = 1270) using PubMed as the sole electronic database. Moreover, subgroup studies were provided based on training intensity and duration, categorized as low intensity-low duration, low intensity-high duration, high intensity-low duration, and high intensity-high duration. Training intensities were standardized to meters per second (m/s), and the training duration was calculated in terms of minutes per session, the number of sessions per week, and the total number of training weeks, which were then converted into minutes. The assessment of neurological recovery following stroke was conducted using standard neurological assessment scales. Results: This meta-analysis in humans found a notably positive standardized mean difference in protocols with high intensity and high duration (1.792; 95% CI = 0.566 to 3.02). Conclusions: In conclusion, the current meta-analysis suggests that practitioners using the high intensity-high duration protocol should regularly monitor the neurological outcomes, as they may be negatively impacted by the intensity and duration of the protocol.

Future of Uremic Toxin Management

During the progression of chronic kidney disease (CKD), the retention of uremic toxins plays a key role in the development of uremic syndrome. Knowledge about the nature and biological impact of uremic toxins has grown exponentially over the past decades. However, the science on reducing the concentration and effects of uremic toxins has not advanced in parallel. Additionally, the focus has remained for too long on dialysis strategies, which only benefit the small fraction of people with CKD who suffer from advanced kidney disease, whereas uremic toxicity effects are only partially prevented. This article reviews recent research on alternative methods to counteract uremic toxicity, emphasizing options that are also beneficial in the earlier stages of CKD, with a focus on both established methods and approaches which are still under investigation or at the experimental stage. We will consequently discuss the preservation of kidney function, the prevention of cardiovascular damage, gastro-intestinal interventions, including diet and biotics, and pharmacologic interventions. In the final part, we also review alternative options for extracorporeal uremic toxin removal. The future will reveal which of these options are valid for further development and evidence-based assessment, hopefully leading to a more sustainable treatment model for CKD than the current one.

Is there a maximum transfer time for safe planned home births? Building evidence to

Abstract Evidence-based assessment of suitability for planned home birth (PHB) is a critical component of safe, effective home birth services. This study aimed to build an evidence base to inform transfer time recommendations for the Health Service Executive (HSE) Home Birth Service in Ireland. Transfer rates, time and distance were described for women who began labour at home with the HSE Home Birth Service between 2012 and 2021. Binary logistic regression was used to identify factors associated with intrapartum transfer and to examine the relationship between transfer time and outcomes. A survey on home birth policy and practice was issued to informants in countries offering comparable services to the HSE. Of 2,000 women initiating labour at home, 376 (18.9%) required intrapartum transfer, with transfer rates of 48.2% and 10.1% for primiparous and multiparous women, respectively. Primiparity (aOR: 8.95, 95% CI 6.89-11.7, p < 0.001) and maternal body mass index ≥30 (aOR: 1.93, 95% CI 1.14-3.20, p = 0.013) significantly increased the odds of intrapartum transfer. Serious adverse outcomes were rare in those requiring intrapartum transfer. No statistically significant increase in poor outcomes was detected with increasing transfer time; however, statistical power to detect small but important effects was limited. In other home birth services, transfer time is explicitly considered when assessing suitability; information provided to women includes details on transfer rates and times. While this study did not find a threshold time associated with increased risk of adverse outcomes for PHB, it has highlighted the significance of transfer time in shared decision-making on birthplace. Women considering PHB should receive parity-specific information on outcomes including transfer rates. This work highlights the pivotal role of Public Health in ensuring that evidence is combined with expert judgement and womens’ preferences to provide high quality, accessible, person-centred services. Key messages • Transfer time plays a key role in supporting shared decision-making for women considering a home birth. • This study identified opportunities to extend the comprehensiveness of assessment of suitability for planned home births using local and international evidence.

Starting Right, an evidence-based assessment of children in municipalities healthcare centers

Abstract During the last century, children’s health has evolved significantly, with mental health issues becoming a prominent public health concern. Childhood health problems profoundly impact quality of life (QoL), development, school functioning, and social interactions, affecting society broadly. In Norway, child and school health services offer free comprehensive care within the municipal primary health care system, prioritizing health promotion and prevention to address social health inequalities. The Norwegian Starting RightTM project recruits’ children aged 6 months to16 years and their parents, emphasizing early intervention and support to reduce health inequalities and promote well-being. In the Starting RightTM project, online proxy- and child-reported questionnaires are used to support public health nurses (PHNs) in assessing children’s health and development in routine follow- up. Parents and children receive an SMS text message asking them to answer an online questionnaire before attending their regular appointments in child or school health services. Validated instruments measure the development (ASQ, ASQ-SE), mental health (SDQ) and health-related quality of life (HRQoL), (KIDSCREEN -27). By mapping children and adolescents’ health and through discussions with PHNs, parents and children may be more involved in children’s health and development and may increase their Health Literacy. The primary objective of the proposed project is to develop child and school health services and improve children’s health and HRQoL. The ongoing project is the first to systematically assess development, health and HRQoL in children and adolescents in Norway through ordinary services, and to do so longitudinally. At present, >2000 children have been included. The large sample size combined with a broad multi- and interdisciplinary approach is unique from a national perspective. The upcoming workshop will showcase findings from this innovative study.

4.N. Scientific session: Equity in Child Health: Leveraging Universal Health Promotion Services for Families Amid Uncertainty

Abstract This workshop addresses the urgent need to foster resilience and equity in child health within the context of an increasingly uncertain Europe. Rapid societal changes, exacerbated by events such as the COVID-19 pandemic and heightened risks of conflict, climate change and economic instability, underscore the importance of nurturing environments where children can thrive despite challenging circumstances. The workshop aims to explore strategies for promoting well-being and addressing social inequalities in child health within the context of universal health promotion services, such as school health services and child health clinics. Objectives are to 1) Elucidate the importance and impact of universal health promotion services in addressing social inequalities and promoting equitable opportunities for all children, regardless of background or circumstance; 2) Identify actionable steps for interventions mitigating social inequalities and promoting equitable opportunities focusing on health literacy among parents with immigrant backgrounds; 3) Showcase successful models and initiatives in universal healthcare and health promotion services for children and families, emphasizing early intervention and standardized evaluation tools; and 4) Facilitate dialogue and knowledge exchange among professionals, policymakers, and stakeholders involved in child and adolescent health promotion. This workshop’s added value lies in its multidisciplinary approach, fostering collaboration for innovative solutions in child health resilience and equity. The coherence between presentations lies in their joint focus on addressing social inequalities in the context of universal health promotion services for children and families. Each presentation offers a unique perspective on these themes, contributing to a comprehensive understanding of the challenges and opportunities in child health promotion. • Hanne Nissen Bjørnsen’s presentation on the role of universal services in public health and addressing social inequality sets the stage by examining the structural factors contributing to disparities in child health outcomes. • Kirsti Riiseŕs presentation conveys the importance of user, stakeholder, and community involvement in creating culturally sensitive strategies for effective health promotion services in the context of health literacy among parents with immigrant backgrounds • Kristin Haraldstad’s presentation on Starting Right, an evidence-based assessment of children in municipalities healthcare centers, highlights the importance of early intervention and targeted support in mitigating health inequalities and promoting well-being. Format of the workshop: Three 10-minute presentations followed by a 20-minute moderated discussion to delve into empowerment and equity in child health, encouraging rich idea exchanges. Key messages • Leveraging universal health promotion services effectively empowers children and families while addressing social inequalities amidst periods of uncertainty. • Collaborative, user-centered approaches and evidence-based working strategies are key to promoting equity and building resilience in child health.

Development and Characterization of a Human Mammary Epithelial Cell Culture Model for the Blood-Milk Barrier-A Contribution from the ConcePTION Project.

It is currently impossible to perform an evidence-based risk assessment for medication use during breastfeeding. The ConcePTION project aims to provide information about the use of medicines during lactation. The study aimed to develop and characterize an in vitro model of the blood-milk barrier to determine the extent of the milk transfer of xenobiotics, relying on either on human mammary epithelial cells (hMECs) or immortalized cell lines derived from breast tissue. The hMECs were cultured and characterized for epithelial markers; further, the ability to form an epithelial barrier was investigated. Drug transporter functionality in the cultured hMECs was analyzed with specific probe substrates. The hMECs showed an epithelial morphology and the expression of epithelial markers and tight junctions. They formed a reproducible tight barrier with a transepithelial electrical resistance greater than 400 Ωcm2, unlike immortalized cell lines. Different levels of mRNA expression were detected for 81 genes of membrane transporters. Functional assays showed no evidence for the transporter-mediated secretion of medicines across the hMECs. Nevertheless, the hMEC-based in vitro model covered a 50-fold range of permeability values, differentiating between passive transcellular and paracellular-mediated transport. The cultured hMECs proved to be a promising in vitro model for biorelevance; the wide characterization of hMECs makes them useful for studying medicine partitioning in milk.

Cancers attributable to diet in Italy.

Cancer burden can be reduced by controlling modifiable risk factors, including diet. We provided an evidence-based assessment of cancer cases and deaths attributable to diet in Italy in 2020. We considered dietary factor-cancer type pairs for which the World Cancer Research Fund/American Institute for Cancer Research - Continuous Update Project reported either 'convincing' or 'probable' evidence of causal association. Relative risks were retrieved from recent meta-analyses and dietary intakes (around 2005) from a national food consumption survey. Sex-specific population attributable fractions (PAFs) were computed by comparing the distribution of dietary intakes in the Italian population against counterfactual scenarios based on dietary recommendations. Using data from national cancer and mortality registries in 2020, we estimated the number of attributable cancer cases and deaths, assuming ~15-year lag period. Unhealthy diet accounted for 6.3% (95% CI: 2.5%-9.9%) of all cancer cases in men and 4.5% (95% CI: 1.7%-7.4%) in women. PAFs of colorectal cancer were 10.5% and 7.0% for any intake of processed meat, 3.3% and 2.0% for high red meat, 4.8% and 4.3% for low dairy products, and 7.9% and 9.0% for low fiber intakes in men and women, respectively. PAFs for low intake of non-starchy vegetables and fruit ranged from 0.8% to 16.5% in men and 0.6%-17.8% in women for cancers of the aerodigestive tract. The estimated cancer burden associated with unfavorable dietary habits in Italy is considerable, but appears lower than for other high-income countries, reflecting the typically Mediterranean diet.

Measuring evidence-based practice knowledge, skills, attitudes, and behavior in students of manual therapy education programs: A scoping review of instruments and their measurement properties.

The purpose of this review was to identify assessment instruments and their measurement properties for assessing evidence-based practice (EBP) knowledge, skills, attitudes, and behavior among students of manual therapy education programs. 7 electronic databases were systematically searched from inception to May 19, 2023. (MEDLINE, EMBASE, CINAHL, ERIC, EBSCO Discovery, LISA, Google Scholar.) Search terms were subject headings specific to each database (MeSH in MEDLINE) and relevant to evidence-based practice, assessment tools/instruments, and manual therapy healthcare professions. Eligible studies included students of manual therapy education programs (chiropractic, physiotherapy, occupational therapy, osteopathy) and provided evidence supporting instrument measurement properties (reliability, validity). Titles and abstracts were screened by 2 reviewers. Data on each instrument and its properties were extracted and tabulated by 2 reviewers. Instruments were compared using the Classification Rubric for EBP Assessment Tools in Education (CREATE) framework including the 5 steps in the EBP model. Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist were followed. 5 studies were identified, (3 physiotherapy, 2 chiropractic) Two studies used a physiotherapy-focused modification of the Fresno test. One study presented the Knowledge of Research Evidence Competencies instrument. Two studies presented original instruments. Instruments focused on the knowledge domain and did not assess all 5 EBP model steps. The current literature does not address all 5 steps of the EBP model. The identified instruments have the potential to ensure chiropractic institutions are graduating chiropractors who are highly skilled in evidence-based practice.

Guideline for rehabilitation assessment and treatment of adolescent idiopathic scoliosis (2024 edition)

Scoliosis is a complex three-dimensional deformity of the spine that affects the growth of the spine in adolescent, leading to a heavy burden on families and society. According to the guidelines for the treatment of scoliosis, most adolescent idiopathic scoliosis (AIS) requires rehabilitative intervention. So far there has been a lack of scientific, evidence-based, and standardized rehabilitation assessment and treatment for AIS in China. Therefore, in order to promote the standardization of rehabilitation assessment and treatment for AIS, Chinese Society of Physical Medicine and Rehabilitation organized the domestic experts in multiple disciplines such as rehabilitation medicine, orthopedics, pediatric surgery, radiology, evidence-based medicine, etc., who has conformed to the principles of scientificity, safety, efficacy and advancement to propose the 19 recommendations of 8 categories using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Reporting Items for Practice Guidelines in Healthcare (RIGHT). Through the steps of literature search, evaluation, and establishment of direction and intensity of recommendation opinions, 19 recommendations were formed, involving AIS screening, assessment and treatment.

Write here write now. What can we learn from the writing goals of people with aphasia?

ABSTRACT Background People with aphasia commonly have difficulties with producing written language (dysgraphia). Greater understanding of people with aphasia’s rehabilitation goals for writing can inform development of evidence-based assessment and management tools. Aims This qualitative study aimed to explore the nature of writing goals of people with aphasia who attended an intensive speech and language therapy (SLT) centre. Methods and Procedures Qualitative data was obtained from five years-worth of client SLT reports from an intensive aphasia centre. Using qualitative content analysis, a deductive coding framework was used to identify any description of writing goals; coding incorporated iterative refinement and agreement among authors. Themes were then constructed to reflect clients’ goals to inform writing assessment and therapies. Outcomes and Results Qualitative analysis focused on content describing 66 goals on writing from 87 reports. There were two dominant interrelated themes: Supporting Communication (33 goals) and Technology (25 goals). Technology included subthemes on Emailing, Texting, Social Media, and Assistive Technology. Two smaller themes were Impairment Focused (4 goals), where goals did not have a clear functional direction, and Other (4 goals), where goals targeted specific writing activities, e.g. crosswords. Conclusions These thematic findings demonstrate the varied real-life goals for writing among attendees at an aphasia centre. They highlight the nature of relatively early-stage rehabilitation goals for individuals with aphasia, focusing on supporting communication and returning to valued activities. The results provide a context within which we can scrutinise the adequacy of current clinical tools to support goal setting, assess functional writing and design interventions for acquired writing difficulties. Further guidance is needed on assessment of writing as a supportive communication strategy and therapy towards improving this skill. There are also gaps in supporting the personal goals of people with aphasia who wish to produce written language via technology or in online environments. Future research should recognise these priorities and work together with people with aphasia, clinicians, and technology specialists to address an area of clinical need.

Exploring Indoor Home Environment Factors Influencing Fear of Falling: A Systematic Review.

In-home falls and fear of falling (FOF) are significant concerns among older adults and people with disabilities (PwD), impacting independence in daily lives. The indoor home environment (IHE) plays an important role in influencing FOF, as it is influenced by barriers and facilitators within the home. This systematic review provides an evidence-based list of IHE factors and investigates their association with FOF, especially in older adults, PwD, and wheelchair users. Examining 24 studies, we found associations between IHE factors and FOF, suggesting the importance of home modifications to live in a supportive environment to reduce FOF. Most studies were experimental and intervened for either single or multiple IHE factors, indicating reasonably strong evidence. Our findings highlight the importance of considering psychological factors when evaluating home environments to reduce FOF. The list of barriers and facilitators we provide can help healthcare professionals conduct evidence-based home assessments.

Six of one, half a dozen of the other? Examining measurement properties of different potentially traumatic event polyvictimization operationalizations using a multiverse analysis framework.

Numerous differences exist between and within research projects related to assessment and operationalization of potentially traumatic events (PTEs) for youth, especially when measuring polyvictimization. However, few studies have systematically examined how polyvictimization measurement differences influence PTE's relation to functioning. This study sought to address these knowledge gaps by conducting a secondary data multiverse replication (SDMR) to systematically (re)evaluate PTE polyvictimization measurement approaches. Participants included 3297 adolescents (Mage = 14.63; 50.59% female; 65.15% white) from the National Survey of Adolescents-Replication study who completed a structured interview on PTE exposure and emotional and behavioral health (i.e., posttraumatic stress and major depressive disorder, drug and alcohol use, and delinquency). Results indicated that PTE operationalizations using a count variable tended to demonstrate better model performance and prediction of youth at-risk of emotional and behavioral health challenges, compared to models using a binary (yes/no) PTE operationalization. Differences in model performance and prediction were less distinct between models examining multiple forms of a single type of PTE (e.g., maltreatment, community violence), compared to models examining multiple PTE types. These findings emphasize the importance of using multidimensional approaches to PTE operationalization and the need for more multiverse analyses to improve PTE evidence-based assessment.

Improving childhood cancer care in South Africa using the Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool

Aim Using the St. Jude Paediatric Oncology Facility Integrated Local Evaluation (PrOFILE) tool, the South African Association of Paediatric Haematology Oncology (SAAPHO) collaborated with St Jude Children’s Research Hospital to evaluate the delivery of health services and provide evidence-based assessments to inform and prioritise action plans to improve childhood cancer care. Methods PrOFILE was used to assess paediatric oncology care in thirteen public-sector hospitals comprehensively. Following that, representatives from each of the thirteen public-sector hospitals and from SAAPHO, the National Department of Health, the World Health Organization, St. Jude Global, and Childhood Cancer Foundation South Africa participated in a national stakeholder prioritisation workshop. Participants were assigned one of the PrOFILE components (Context, Workforce, Diagnostics, Multidisciplinary Team, Therapy, or Patients and Outcomes), forming six working groups to assess, map, and evaluate childhood cancer topics. Using a modified implementation mapping approach and through participation in structured co-designed activities, each group designed multi-level health interventions: prioritising initiatives identified by the SAAPHO, setting goals for each priority, co-designing project-specific logic models, reviewing potential barriers to implementation, and developing a post-workshop agenda. Results Individual hospital reports and a national aggregate report were compiled to discuss opportunities and priorities. The goal of the workshop was to utilise evidence-based assessments to achieve, a) objective assessment data to inform prioritisation exercises conducted by stakeholders, and b) priorities and action plans to inform childhood cancer control activities and demonstrate national organisation, human resources capabilities, and technical support to improve childhood cancer care. Through structured discussion and voting, six priority areas were identified and assigned to working groups: redrafting the organisation’s constitution, standardising multidisciplinary reporting, developing protocols and treatment guidelines, establishing fever-management guidelines, strengthening chemotherapy safety practices, and enhancing hospital-based cancer registries. Conclusions An implementation map enabled stakeholders to develop actionable plans, the success of which is demonstrated by the active implementation of the identified priorities by the focused working groups. This could serve as a model for countries with identified priorities but need more means to implement them. Based on mapping and outputs from the PrOFILE workshop, the NDoH will facilitate the creation of a childhood cancer committee to sustain progress on the key themes and priorities identified through the PrOFILE mapping process.

A novel framework for evidence-based assessment of flood resilience integrating multi-source evidence: A case study of the Yangtze River Economic Belt, China

Floods are extremely destructive to the society, economy and nature, and severely restrict sustainable urban development. There is an urgent need to assess the level of flood resilience, analyze its evolutionary characteristics and improve the flood resilience of the region. However, few previous studies have integrated multi-source evidence into a framework for assessing flood resilience over a longer time span. This study integrated multi-source evidence to analyze the Yangtze River Economic Belt, including literature-based evidence, policy texts and social media data. Subsequently, the Kruskal algorithm and Jaccard coefficient were used to construct collinear networks and identify the clustering dimensions of flood resilience. After evidence judgment, a flood resilience indicator system was constructed. The flood resilience index was calculated using the improved Critic method. The dynamic evolution characteristics and key influencing factors were illustrated by the Kernel density and Grey correlation methods, respectively. The principal contribution is to integrate multi-source evidence to assess flood resilience, with a newly constructed indicator system that systematically considers local public demand, policy priorities and common indicators from previous literature. The results show that: the flood resilience index of the Yangtze River Economic Belt is in the range of [0.16, 0.75] from 2000 to 2022, with higher values in the downstream compared to those in the midstream and upstream. The social dimension dominating the overall flood resilience. The kernel density curve of the YREB is characterized by a right trailing. The inter-regional differences tend to widen and have a polarization effect. The special funds for water conservancy finances and the length of flood prevention levees are key factors influencing the level of flood resilience. Finally, strategies for enhancing flood resilience were proposed. This study provides a feasible framework for constructing an indicator system and assessing flood resilience by integrating multi-source data. It is important for flood risk management and helps to the development of urban flood prevention and resilience strategies.

Early intervention speech-language pathologists’ beliefs and practices related to assessing dual language learners

IntroductionEarly intervention (EI) speech-language pathologists (SLPs) are required to provide culturally and linguistically responsive assessments for dual language learners (DLLs). However, SLPs consistently report feeling underprepared to assess DLLs and research demonstrates gaps in implementation of best practices in pediatric outpatient and school-based settings. This study was designed to understand EI SLPs’ beliefs and practices related to assessing DLLs referred to early intervention programs. MethodsA total of 132 EI SLPs completed a survey in which they were asked to describe their assessment procedures for a DLL case scenario and were further asked to identify the degree to which they agreed with a variety of assessment practices for assessing DLLs. ResultsResults revealed that EI SLPs’ beliefs aligned with best practices for assessing DLLs. However, substantial gaps exist between EI SLPs’ beliefs and their self-reported practices for assessing DLLs. ConclusionsThese results suggest DLLs may not be receiving evidence-based EI assessments, leading to the potential perpetuation of both over- and under-diagnosis of speech and language delays within this population. Implications include the need to increase the quality of EI SLPs assessment practices through additional training, the removal of systems-level barriers, and the continued need for increased training within preprofessional training programs.

Evidence-Based Critical Assessment of the Success Rate of Dental Implants in Smokers: An Umbrella Systematic Review.

The aim of this umbrella systematic review is to evaluate the success rate and osseointegration of dental implants in patients with a smoking habit. Electronic database searches of PubMed/Medline, Google Scholar, ScienceDirect, Cochrane Library, and EBSCOhost were done from 2006 until August 2024, using medical subject headings (MeSH) terms. Systematic reviews and meta-analyses (SRMAs) investigating the association between smoking and the rate of success of dental implants based on dental implant failure, marginal bone loss, survival, and peri-implant parameters were deemed eligible. The Assessment of Multiple Systematic Reviews Tool 2 (AMSTAR 2) was used to assess the quality of the included SRMAs. Seventeen systematic reviews have been included. In the reviews, 10 studies included meta-analyses (MAs) that evaluated implant failure rate and marginal bone loss. According to the AMSTAR 2 checklist, one review was scored "high," seven reviews were scored "moderate," seven reviews were scored "low," and two reviews were scored "critically low" quality. The strength of evidence suggests a low level of success and high rate of failure of osseointegration of dental implants in smokers. However, the influence of smoking on the rate of dental implant failure seems to be associated with various factors such as peri-implant inflammatory markers, post-operative infections, etc. Inherently, the conclusion of this review is based on a limited number of systematic reviews.

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.