Full Systematic Reviews Research Articles

European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illness.

Respiratory symptoms are ubiquitous and impair health-related quality of life in people with respiratory disease. This European Respiratory Society (ERS) task force aimed to provide recommendations for symptomatic treatment in people with serious respiratory illness. The ERS task force comprised 16 members, including representatives of people with serious respiratory illness and informal caregivers. Seven questions were formulated, six in the PICO (Population, Intervention, Comparison, Outcome) format, which were addressed with full systematic reviews and evidence assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). One question was addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. To treat symptoms in people with serious respiratory illness, the task force suggests the use of graded exercise therapy (conditional recommendation, low certainty of evidence); and suggests the use of a multicomponent services, handheld fan and breathing techniques (conditional recommendations, very low certainty of evidence). The task force suggests not to use opioids (conditional recommendation, very low certainty of evidence); and suggests either administering or not administering supplemental oxygen therapy (conditional recommendation, low certainty of evidence). The task force suggests that needs assessment tools may be used as part of a comprehensive needs assessment, but do not replace patient-centred care and shared decision making (conditional recommendation, low certainty of evidence). The low certainty of evidence, modest impact of interventions on patient-centred outcomes, and absence of effective strategies to ameliorate cough highlight the need for new approaches to reduce symptoms and enhance wellbeing for individuals who live with serious respiratory illness.

PP01 Health Technology Assessment Of Cervical Artificial Disc Replacement: Highlighting The Need For A Consistent International Approach

IntroductionCervical artificial disc replacement (C-ADR) is not a new technology but one that has seen many technological advances in the past 10 years. Indeed, a recent review described total disc arthroplasty as the most innovative development in the history of spinal surgery. The primary goals of C-ADR are to reduce or eliminate pain, and restore normal segmental motion. The aim of this analysis was to identify, extract and examine key health outcomes and economic data from published health technology assessment (HTA) reports on C-ADR, with the aim of understanding how the evolution of this technology has influenced assessments internationally.MethodsA comprehensive search of over 90 HTA organization websites and the INAHTA HTA database using key terms for C-ADR surgical procedures was coupled with a literature search of recent systematic reviews. No language restrictions were applied.ResultsTwenty HTA reports of C-ADR surgery published from 2005 to 2022 were included for review. Several HTAs (4/20) were updates or reassessments by the same agency and one was an update across agencies (Italy update of Belgian HTA). While many of the HTAs concluded C-ADR is as effective as standard care and superior in certain outcomes, there was no pattern or consistency in the conclusions or recommendations from these assessments, even as the evidence base expanded over time. Our analysis found this was largely due to variations in HTA approaches among agencies including: differences in research questions asked, PICO (Population, Intervention, Comparator, Outcomes) criteria and methods performed, such as: rapid versus full systematic reviews; inclusion of economic evaluations and/or budget impact analyses.Indeed, one of the only predictive factors for a positive HTA was a favorable cost-effectiveness analysis.ConclusionsC-ADR is an established technology with extensive HTA investigation internationally. The lack of a consistent approach taken by HTA bodies made prediction of successful HTA outcomes difficult. Future alignment of key evaluation processes and methods may help address current international variations and support consistent decision making on patient access.

European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease.

There is increased awareness of palliative care needs in people with COPD or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD. The ERS task force consisted of 20 members, including representatives of people with COPD or ILD and informal caregivers. Eight questions were formulated, four in the Population, Intervention, Comparison, Outcome format. These were addressed with full systematic reviews and application of Grading of Recommendations Assessment, Development and Evaluation for assessing the evidence. Four additional questions were addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. The following definition of palliative care for people with COPD or ILD was agreed. A holistic and multidisciplinary person-centred approach aiming to control symptoms and improve quality of life of people with serious health-related suffering because of COPD or ILD, and to support their informal caregivers. Recommendations were made regarding people with COPD or ILD and their informal caregivers: to consider palliative care when physical, psychological, social or existential needs are identified through holistic needs assessment; to offer palliative care interventions, including support for informal caregivers, in accordance with such needs; to offer advance care planning in accordance with preferences; and to integrate palliative care into routine COPD and ILD care. Recommendations should be reconsidered as new evidence becomes available.

Racism, Discrimination, and Harassment in Medical Schools in the UK: A Scoping Review

Background: Discrimination, racism, harassment, stereotyping, and bullying are a significant issue for medical students as they create a hostile environment with detrimental effect on student wellbeing and educational experience. Findings suggest that though prevalent, reporting of these experiences is rare and perceived as ineffective. Objectives: This scoping review aims to map the trends, types, and nature of discrimination, harassment, bullying, stereotyping, intimidation, and racism reports in undergraduate medical education in the UK since 2010 and to determine areas of focus for undertaking full systematic reviews in the future. Method: A search was conducted using the MEDLINE, AHMED, CINHL, and EMBASE electronic databases from 2010 up to February 2022 in English. Only primary research papers (e.g., cohort studies, cross-sectional studies, and case series) that report the words/phrases discrimination (including gender and racial), harassment (including verbal, sexual, academic, and physical), bullying, stereotype, intimidation, and racism within medical education in the UK after 2010, following the Equity Act 2010, were eligible for inclusion. Results: Five relevant articles relating to discrimination, harassment, bullying, stereotyping, intimidation, and racism in medical schools in the UK were included. Three themes were identified across these studies. Conclusions: The data suggest that there is a high prevalence rate of discrimination, harassment, and stereotyping being experienced by ethnic minority undergraduate medical students in the UK. There is underreporting due to perceived and structural barriers. The identified studies suggest that less progress has been made in these areas.

The effect of selective ultrasound screening on the incidence of late presentation of developmental hip dysplasia-a meta-analysis.

Different screening strategies for developmental dysplasia of the hip (DDH) exist. Despite screening efforts, cases of late presentation continue to occur, often necessitating surgery. This systematic review and meta-analysis assess the effect of newborn selective ultrasound screening for DDH on the incidence of late presentation in infants and children, compared to a universal ultrasound strategy. A systematic search across Medline and EMBASE databases was performed between January 1950 and February 2021. A consensus-based evaluation of abstracts led to retrieval of relevant full text, original articles or systematic reviews in English only. These were assessed according to agreed eligibility criteria, and their reference lists were reviewed to identify additional eligible publications. Following final consensus on included publications, data was extracted, analysed and reported as per PRISMA and Prospero (CRD42021241957) guidelines. The 16 eligible studies consisted of 2 randomised controlled trials and 14 cohort studies, published between 1989 and 2014, with a total of 511,403 participants. In total, 121,470 (23.8%) received a neonatal hip ultrasound, of whom 58,086 and 63,384 were part of a selective or a universal ultrasound screening strategy, respectively. The difference in the proportion of late presentation between the universal and selective strategies was 0.0904 per 1,000 (P = 0.047). The time effect, i.e. the difference between early and late presentation defined respectively, as less than and more than 3 months of age, regardless of screening strategy, was not significant (P = 0.272). Although there was variability in study design and reporting, the quality of the evidence, based on the critical appraisal skills programme appraisal tools, was generally good. Compared to universal ultrasound screening for DDH, selective screening resulted in a slightly higher rate of late presentation. Uniformity in design and reporting of DDH studies and a cost-effectiveness analysis are needed.

Use of systematic evidence maps within the US environmental protection agency (EPA) integrated risk information system (IRIS) program: Advancements to date and looking ahead.

Systematic evidence maps (SEMs) are increasingly used to inform decision-making and risk management priority-setting and to serve as problem formulation tools to refine the focus of questions that get addressed in full systematic reviews. Within the U.S. Environmental Protection Agency (EPA) Office of Research and Development (ORD) Integrated Risk Information System (IRIS), SEMs have been used to inform data gaps, determine the need for updated assessments, inform assessment priorities, and inform development of study evaluation considerations, among other uses. Increased utilization of SEMs across the environmental health field has the potential to increase transparency and efficiency for data gathering, problem formulation, read-across, and evidence surveillance. Use of the SEM templates published in the companion text (Thayer et al.) can promote harmonization in the environmental health community and create more opportunities for sharing extracted content.

Reflections on conducting rapid reviews of educational research

ABSTRACT Background Rapid reviews involve a streamlined approach to knowledge synthesis. They are used to identify high-quality evidence for the purpose of informing decisions and initiatives, completed over relatively short timeframes, and have been found to reach conclusions that do not differ extensively from full systematic reviews. Although common in the health sector, rapid reviews are not as widespread in education. Purpose This paper reflects on the experiences of conducting a rapid review that applied review guidance from the health sector to a topic situated within education: effective Professional Learning (PL) for school-based educators. Our purpose is not to share the rapid review’s findings: rather, our interest lies in exploring the process of undertaking the review. We sought to investigate the methodological decisions we made for the education context as we carried out the review. Methods As part of a large-scale investigation focusing on practitioner use of research evidence in education, we undertook a rapid review to understand what is known about effective PL. Drawing on methodological literature from the health and education sectors, we documented the procedure involved in conducting our rapid review in education. At each step, we reflected on methodological issues encountered, decisions taken and the procedural adjustments we made to align the process to the education context. Findings Our reflections identify the key adaptations we made to ensure that review guidance was carefully attuned to the context of the education field and the wider purpose of the review: in our case, to inform an initiative in education. Considerations highlighted by our procedure also included the role of reviewer judgement in quality appraisal and attending to collaborative review team processes. These reflections support the notion that the use of research to inform decisions in education needs to be a dynamic, contextualised, and collaborative process. Conclusion Rapid reviews have a crucial part to play in efforts to strengthen evidence-informed practice in the education sector. Our methodological exploration offers insights for those conducting, using, and commissioning rapid reviews to provide systematic and transparent evidence-based guidance for initiatives in education.

Key Care Provision Aspects That Affect Care Transition in the Long-Term Care Systems: Preliminary Review Findings.

The aim of this brief report is to present the protocol and preliminary findings of a systematic review on key aspects of care provision that affect care transition of older adults 60+ within the long-term care systems. This brief report describes and classifies the relevant literature found in the review with the purpose to provide a base for further full systematic reviews, and to outlines a model of organizational and financing aspects that affect care transition. Our search was conducted in MEDLINE, Embase and CINAHL on 2 March 2020, before the COVID-19 pandemic. The protocol was registered at the International Prospective Register of Systematic Reviews (number: CRD42020162566). Ultimately, 229 full-text records were found eligible for further deliberation. We observed an increase in the number of publications on organizational and financial aspects of care transition since 2005. Majority of publications came from the United States, United Kingdom and Australia. In total, 213 (92%) publications discussed organizational aspects and only 16 (8%) publications were related to financial aspects. Records on organizational aspects were grouped into the following themes: communication among involved professional groups, coordination of resources, transfer of information and care responsibility of the patient, training and education of staff, e-health, education and involvement of the patient and family, social care, and opinion of patients. Publications on financial aspects were grouped into provider payment mechanisms, incentives and penalties. Overall, our search pointed out various care provision aspects being studied in the literature, which can be explored in detail in subsequent full systematic reviews focused on given aspects. We also present a model based on our preliminary findings, which enables us to better understand what kind of provision aspects affect care transition. This model can be tested and validated in subsequent research. Understating factors that affect care transition is crucial to improve the quality of transitions and ultimately the outcomes for the patients.

Characteristics of registered and published systematic reviews focusing on the prevention of COVID-19: a meta-research study

ObjectiveWe investigated characteristics of systematic reviews (SRs) assessing measures to prevent COVID-19 by (1) identifying SR registrations in Prospective Register of Systematic Reviews (PROSPERO), (2) identifying published SRs in COVID-19...

Evidence to Underpin Vitamin A Requirements and Upper Limits in Children Aged 0 to 48 Months: A Scoping Review.

Vitamin A deficiency is a major health risk for infants and children in low- and middle-income countries. This scoping review identified, quantified, and mapped research for use in updating nutrient requirements and upper limits for vitamin A in children aged 0 to 48 months, using health-based or modelling-based approaches. Structured searches were run on Medline, EMBASE, and Cochrane Central, from inception to 19 March 2021. Titles and abstracts were assessed independently in duplicate, as were 20% of full texts. Included studies were tabulated by question, methodology and date, with the most relevant data extracted and assessed for risk of bias. We found that the most recent health-based systematic reviews and trials assessed the effects of supplementation, though some addressed the effects of staple food fortification, complementary foods, biofortified maize or cassava, and fortified drinks, on health outcomes. Recent isotopic tracer studies and modelling approaches may help quantify the effects of bio-fortification, fortification, and food-based approaches for increasing vitamin A depots. A systematic review and several trials identified adverse events associated with higher vitamin A intakes, which should be useful for setting upper limits. We have generated and provide a database of relevant research. Full systematic reviews, based on this scoping review, are needed to answer specific questions to set vitamin A requirements and upper limits.

Thulium fiber laser utilization in urological surgery: A narrative review

The thulium fiber laser (TFL) is a novel technology under active investigation as an conceivable alternative to the Holmium:yttrium-aluminum-garnet (Ho:YAG) laser, which is currently the gold standard for an array of urologic procedures. The purpose of this review is to discuss the existing literature on the functionality and effectiveness of TFL in urological practice. We conducted a search of the PubMed, Medline, Web of Science Core Collection, SCOPUS, Embase (OVID), and Cochrane Databases for all full articles and systematic reviews on the TFL. We found a total of 35 relevant pieces of literature. The early research findings pertaining to the TFL exhibit numerous potential advantages over the Ho:YAG laser. In vitro and ex vivo studies have highlighted the TFL's ability to utilize smaller laser fibers, obtain faster stone ablation rates, and achieve less retropulsion when tested against the Ho:YAG laser in lithotripsy. Currently, there is limited in vivo research that investigates the utilization of the TFL. The in vivo results that are available, however, look promising both for laser lithotripsy and soft tissue ablation. Indeed, the existing literature suggests that the TFL has great potential and may possess numerous technological advantages over the Ho:YAG laser, especially in laser lithotripsy. Although these early studies are promising, randomized control trials are needed to assess the full applicability of the TFL in urology.

The fate of urological systematic reviews registered in PROSPERO.

To identify urologic systematic reviews (SRs) registered to PROSPERO that resulted in a publication, and to evaluate their methodological quality and concordance with their stated a priori protocols. We searched PubMed to identify urologic SR protocols registered in PROSPERO that resulted in a publication and assessed their methodological quality and protocols in relation to their stated a priori protocols in PROSPERO. Of the 576 urologic SR protocols registered in PROSPERO up to December 2017, 201 (34.9%) resulted in a full SR publication, but only 40 (17.7%) updated their registration record accordingly. Publications were spread over 100 different journals, with a median time-to-publication of 29months (95% CI 25.0-33.0). The most common topic by far was prostate cancer (59.7%), followed by voiding issues (15.3%), and renal transplantation (15.3%). Only little over half the reviews (52.74%) explicitly stated primary outcome(s) that matched the primary outcome of their corresponding PROSPERO protocol. Notable methodologic deviations from registered protocols included planned restriction on study design (33%), heterogeneity analysis (42%) and planned risk of bias analysis (65.2%). SR authors in urology are increasingly using PROSPERO to register their titles, but our findings indicate that registration alone is not a guarantor of a high-quality SR product. There appears to be a critical need to raise the bar for review authors registering protocols in PROSPERO, with an emphasis on transparency in their publication status updates as well as deviations from their a priori protocols.

Evaluating the Potential Business Benefits of Ecodesign Implementation: A Logic Model Approach

The business benefits attained from ecodesign programs in manufacturing companies have been regularly documented by several studies from both the academic and corporate spheres. However, there are still significant challenges for adopting ecodesign, especially regarding the evaluation of these potential business benefits prior to the actual ecodesign implementation. To address such gap, this study proposes an exploratory and theory-driven framework based on logic models to support the development of business cases for ecodesign implementation. The objective is to offer an outlook into how ecodesign implementation can potentially affect key corporate performance outcomes. This paper is based on a three-stage research methodology with six steps. Two full systematic literature reviews were performed, along with two thematic analyses and a grounded theory approach with the aim of developing the business case framework, which was then evaluated by seven industry experts. This research contributes to the literature of ecodesign especially by laying out an ecodesign-instantiated logic model, which is readily available to be adapted and customized for further test and use in practice. Discussions on the usefulness and applicability of the framework and directions for future research are presented.

Nature-based interventions in institutional and organisational settings: a scoping review

The objective of this review was to scope the literature on nature-based interventions that could be conducted in institutional settings where people reside full-time for care or rehabilitation purposes. Systematic searches were conducted across CINAHL, Medline, Criminal Justice s, PsycINFO, Scopus, Social Care Online and Cochrane CENTRAL. A total of 85 studies (reported in 86 articles) were included. Four intervention modalities were identified: Gardening/therapeutic horticulture; animal-assisted therapies; care farming and virtual reality-based simulations of natural environments. The interventions were conducted across a range of settings, including inpatient wards, care homes, prisons and women’s shelters. Generally, favourable impacts were seen across intervention types, although the reported effects varied widely. There is a growing body of literature on nature-based interventions that could be applied to a variety of institutional settings. Within most intervention types, there is sufficient research data available to perform full systematic reviews. Recommendations for future systematic reviews are offered.

Interagency collaboration models for people with mental ill health in contact with the police: a systematic scoping review

ObjectiveTo identify existing evidence on interagency collaboration between law enforcement, emergency services, statutory services and third sector agencies regarding people with mental ill health.DesignSystematic scoping review. Scoping reviews map particular...

15 A clinical decision tool for prescribing anti-platelet medication for patients with suspected acute coronary syndrome (PAM)

BackgroundThe benefit of antiplatelet medication in confirmed acute coronary syndrome (ACS) is well established. In the Emergency Department (ED) diagnostic uncertainty may lead to over-treatment, with consequent risks (e.g., bleeding),...

Using GRADE to respond to health questions with different levels of urgency

Increasing interest exists in applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to environmental health evidence. While ideally applied to evidence synthesized in systematic reviews and corresponding summary tables, such as evidence profiles, GRADE's correct application requires that “the evidence that was assessed and the methods that were used to identify and appraise that evidence should be clearly described.” In this article, we suggest that GRADE could be applied to evidence assembled from narrative reviews, modelled (indirect) evidence, or evidence assembled as part of a rapid response, if the underlying judgments about the certainty in this evidence are based on the relevant GRADE domains and provided transparently. Health questions that require assessing the certainty in a body of evidence to provide trustworthy answers may range from hours, to days or weeks, to a few months to scenarios that allow assessing evidence without short-term time pressures. Time frames of emergent, urgent or rapid evidence assessments will often require relying on existing summaries or rapidly compiling the available evidence and making assessments. Even without available full systematic reviews, expressing the certainty in the evidence can provide useful guidance for users of the evidence and those who evaluate certainty in effects. The ratings also help clarifying disagreement between organizations tackling similar questions about the evidence. Using the structured GRADE domains, narrative or other summaries of the evidence can be presented transparently.

The benefits of systematic mapping to evidence-based environmental management.

Reviews of evidence are a vital means of summarising growing bodies of research. Systematic reviews (SRs) aim to reduce bias and increase reliability when summarising high priority and controversial topics. Similar to SRs, systematic maps (SMs) were developed in social sciences to reliably catalogue evidence on a specific subject. Rather than providing answers to specific questions of impacts, SMs aim to produce searchable databases of studies, along with detailed descriptive information. These maps (consisting of a report, a database, and sometimes a geographical information system) can prove highly useful for research, policy and practice communities, by providing assessments of knowledge gaps (subjects requiring additional research), knowledge gluts (subjects where full SR is possible), and patterns across the research literature that promote best practice and direct research resources towards the highest quality research. Here, we introduce SMs in detail using three recent case studies that demonstrate their utility for research and decision-making.Electronic supplementary materialThe online version of this article (doi:10.1007/s13280-016-0773-x) contains supplementary material, which is available to authorized users.

Pruning and prioritising: a case study of a pragmatic method for managing a rapid systematic review with limited resources

Full systematic reviews are time and resource heavy. We describe a method successfully used to produce a rapid review of yoga for health and wellbeing, with limited resources, using mapping methods. Inclusion and exclusion criteria were developed a priori and refined post hoc, with the review team blind to the study results to minimise the introduction of bias. This method allowed the review to be tailored to make use of the best available evidence and the health topics of most relevance to the commissioners, and to enable the evidence base to be disseminated to practitioners in a timely fashion.

Editorial for issue 4 of 2013, Journal of Evidence Based Medicine

As 2013 draws to a close, The Cochrane Collaboration is entering its 21st year and we are pleased to be part of those celebrations here at the Journal of Evidence Based Medicine. The recent Cochrane Colloquium saw a gathering of a thousand evidence-based researchers, practitioners and patients from across health and social care in Quebec City, Canada. They were able to look back on the many successes of the Collaboration over its first two decades and anticipate the challenges for the future. More than 31,000 people from over 120 countries are now actively involved in the work of The Cochrane Collaboration. China continues to make a tremendous contribution to this work, with 2700 active participants based in this country. Among these, 2300 are authors on Cochrane Reviews and more than a fifth of them are the contact person for the review. Together, the members of the Collaboration have produced 5500 full Cochrane Reviews over the last 20 years. A further 2300 are at the stage of published protocols. These will be converted to full systematic reviews in the coming years, and be added to by hundreds more. This will maintain the position of the Cochrane Database of Systematic Reviews as the world's largest single repository for the full text of reviews in health and social care. This, coupled with the unique contribution of the Centre for Reviews and Dissemination at the University of York in England which is responsible for DARE, the Database of Abstracts of Reviews of Effects, provides patients, practitioners, policy makers and the public with ready access to the world's systematic reviews, through The Cochrane Library. The driving forces behind Cochrane Reviews are the Cochrane Review Groups, many of whom have published accounts of their work in specialist journals through this year. We are delighted to add to this effort in the current issue of the Journal. You can read articles from a diverse range of Groups, reflecting on their early years and looking to what comes next for them. This future seems set to include greater automation in the review process and Clive Adams, Coordinating Editor of the Cochrane Schizophrenia Group and colleagues, outline a vision for how this might happen elsewhere in this issue.