Methodological Quality Of Reviews Research Articles

Experiences of adult patients living with depression-related insomnia: a qualitative systematic review.

The objective of this review was to identify and synthesize the best available evidence on how adult patients experience living with depression-related insomnia, and their experiences related to pharmacological and non-pharmacological interventions aimed at improving sleep. Insomnia affects 80% to 90% of patients with depression. The costs of insomnia are considerable for the individual and society alike. To understand the role and consequences of insomnia for an individual with depression and to optimize sleep interventions, an in-depth understanding of patients' experiences is needed. Therefore, this review addresses how adult patients experience living with depression-related insomnia, along with the experiences of pharmacological and non-pharmacological sleep interventions among patients with depression-related insomnia. Studies focusing on adult patients aged 18 years and older with a diagnosis of depression who had experiences with insomnia and pharmacological and/or non-pharmacological sleep interventions were included. All studies with qualitative research findings from inpatient and outpatient populations were considered. The following databases were searched: MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (ProQuest), Cochrane CENTRAL, SveMed+, Scopus, and Web of Science Core Collection. Google Scholar and ProQuest Dissertations and Theses were searched for eligible dissertations and theses. The searches were conducted on May 3-5, 2022, and updated on June 13-19, 2023. Studies published in English, Danish, German, Norwegian, and Swedish were considered. Databases were searched from their inception to the search date. All studies were screened against the inclusion criteria and critically and independently appraised by 2 reviewers for methodological quality. Findings were pooled using meta-aggregation, and a ConQual Summary of Findings was created. Ten qualitative studies were included. The studies were conducted in 6 countries and counted a total of 176 participants. In all, 127 findings were extracted and aggregated into 11 categories. From the 11 categories, 3 synthesized findings were developed: 1) Disruption of sleep challenges coping with everyday life by depleting both physical and mental resources; 2) Sleep is an escape and a protective factor against suicide; and 3) Choices, support, and personalized interventions from non-pharmacological approaches addressing depression-related insomnia are valued. This review underlined the relationship between depression-related insomnia, its profound impact on individuals' lives, and the value of non-pharmacological sleep interventions to address these issues. Specifically, the study revealed the physical and emotional consequences of insomnia while emphasizing how wakefulness during night hours may exacerbate feelings of loneliness and vulnerability to negative thoughts and suicide. Moreover, it provides an overview of patients' experiences of non-pharmacological approaches to address depression-related insomnia and highlights their diverse treatment experiences and preferences. A Danish-language version of the abstract of this review is available as Supplemental Digital Content [http://links.lww.com/SRX/A64]. PROSPERO CRD42021276048.

Methodological quality of umbrella reviews in endodontics: A cross-sectional study.

In endodontics, the number of umbrella reviews has increased significantly over the last few years, but there is no evidence that they were methodologically sound. The aim of the current study was to appraise the methodological quality of umbrella reviews in endodontics, and to identify possible predictive factors associated with methodological quality. Umbrella reviews published in the discipline of endodontics until December 2023 were included. The methodological quality of the reviews was evaluated using a checklist consisting of 11 items. Each item in the checklist was evaluated by two independent assessors who assigned a score of '1' if it was fully addressed, '0.5' if it was partially ddressed, and '0' if it was not addressed. Bootstrapped multiple linear regression analysis was used to examine the association between the total scores awarded and five predictor variables (a priori protocol registration, year of publication, number of authors, journal impact factor (IF) and continent of the corresponding author). The statistical significance level was set as 5%. A total of 27 reviews were included. Ninety-six per cent of the reviews adequately reported: eligibility criteria for selecting the reviews, details of the reviews, techniques for assessing the risk of bias or methodological quality of the individual systematic reviews they included. Only 30% of the reviews adequately managed overlapping primary studies within individual systematic reviews. Among the five predictors analysed, a priori protocol registration and journals with IFs were associated with significantly greater total methodological quality scores. Several methodological shortcomings in the umbrella reviews published within the field of endodontics were revealed. Umbrella reviews published in journals with IFs and those with protocols registered a priori had significantly superior methodological quality scores. In endodontics, authors intending to publish umbrella reviews should consider the limitations revealed in this study and follow the appropriate rules to ensure their reviews comply with the highest standards and provide accurate and dependable information and conclusions.

Strategies associated with improved healthiness of consumer purchasing in supermarket interventions: a systematic overview of reviews and evaluation of primary articles.

Growing evidence suggests that it is possible to change the retail food environment to enable healthier choices via in-store interventions. It has been difficult to draw clear conclusions as to which interventions are most effective in positively influencing consumer purchasing behaviour given the significant heterogeneity within the food retail research literature. The aim of this study was to (1) summarise current high-quality systematic, scoping, and/or narrative reviews (Part I: overview of reviews); and (2) synthesise high-quality original research, to understand the range, types and effectiveness of strategies implemented in food retail settings (Part II: evaluation of primary studies). To identify reviews describing the effects of intervention strategies aiming to improve the healthiness of consumer purchasing in supermarkets, a systematic search across seven electronic databases was completed in April 2023. The methodological quality of reviews was assessed using the risk of bias in systematic reviews for systematic and scoping reviews, and the Scale for the Assessment of Narrative Review Articles for narrative reviews. High-quality reviews were further inspected and synthesised narratively (Part I). Next, to understand strategies associated with improved healthiness of consumer purchasing high-quality, primary articles from high-quality reviews identified in Part I were retrieved, and the strategies implemented within these interventions were summarised (Part II). Thirty-eight reviews met the inclusion criteria for Part I; two-thirds (n = 25, 66%) were rated as high-quality (66%). These reviews indicated that pricing strategies had the greatest proportion of reported positive or promising effects on outcomes (n = 8 of 11 reviews, 73%). Twenty reviews met the inclusion criteria for Part II and the 771 primary articles from these reviews were screened with 23 high-quality primary articles included in analysis. Findings indicated that promotional strategies in combination with another strategy appeared to be most successful among regular shoppers (the general population), whereas pricing was most successful in low socio-economic status and rural sub-groups. Promotion, pricing and prompting were the most commonly tested strategies across the overview of reviews and review of primary articles. Promotion, in combination with other strategies, and pricing appear to be most promising, but the effectiveness of pricing strategies may vary by sub-groups of the population. How pricing and promotion in combination with other strategies can be implemented responsibly and sustainably to change purchase habits towards healthier items should be explored further. OSF, https://osf.io/jyg73/.

Rationale, completeness and quality of evidence for the use of ursodeoxycholic acid in neonatal hyperbilirubinemia

Background. Systematic reviews are considered the highest evidence of the effectiveness and safety of treatment methods used in clinical practice. The veracity of a results and conclusions of systematic reviews is directly related to their quality. The aim of the study is an assessment of the currency, completeness and methodological quality of published systematic reviews on the evaluation of the effectiveness of ursodeoxycholic acid (UDCA) for the treatment of neonatal hyperbilirubinemia. Materials and methods. A meta-epidemiological methodological study was conducted. The search for evidence sources was performed in November 2023 in the specialized databases MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), LILACS, CNKI, LENS.ORG, еLibrary.Ru, in registers ClinicalTrials.gov, ICTRP, ISRCTN, PROSPERO, as well as in the Google Academy and Google search engines. Additionally, the lists of references and citations of selected publications have been reviewed. Only systematic reviews and randomized clinical trials are included in the study. The search was carried out to assess the currency and completeness of systematic reviews. A systematic review is considered currency if the most recent studies are included in its analysis. A systematic review is considered complete if its analysis includes all identified studies that meet the inclusion criteria set by the review authors and are published no later than the date of the last search conducted by the review authors. The methodological quality of the systematic reviews was assessed using the AMSTAR-2 tool. Results. As a result of the search, 4 systematic reviews and 23 randomized trials were identified. All reviews evaluated the effect of UDCA in combination with phototherapy on the level of total serum bilirubin, the duration of phototherapy and the frequency of adverse events (for example, loose stools, vomiting, rash) compared with phototherapy alone and/or placebo. All systematic reviews have been published over the past two years, but have already lost their currency. There are missing studies and/or outcomes in each review. The methodological quality of the reviews was found to be extremely low. Conclusion. Given the listed shortcomings of systematic reviews, their results and conclusions should be treated with caution. In order to obtain the most accurate and reliable evidence, a new systematic review is needed.

What’s in store for you? Identifying effective initiatives used in supermarkets to improve consumer purchasing: a systematic review

Supermarkets have been described as having unprecedented and disproportionate power in the food system, influencing population diets through the products they have for sale, their price, store layouts, and other marketing activities(1).There is growing evidence to suggest that changing the retail food environment to be more health-enabling via in-store interventions is possible. The purpose of this study was to review the available high-quality evidence reporting on the effectiveness of real-world supermarket-based interventions on improving the healthiness of consumer purchases and consumption. First, a systematic search across seven electronic databases was completed in April 2023 to identify reviews describing the effects of intervention strategies that aimed to improve the healthiness of consumer purchasing in supermarkets and grocery stores (overview of reviews). The methodological quality of reviews was assessed using the Risk of Bias In Systematic Reviews for systematic and scoping reviews, and the Scale for the Assessment of Narrative Review Articles for narrative reviews. Review findings were synthesised narratively. Next, high-quality, primary studies from these reviews were further inspected (review of primary studies). In-store interventions were categorised by strategy type(2), and outcome effects were coded as effective (positive/promising), ineffective or mixed/unclear(3). Results were synthesised narratively, and separately for population subgroups. Thirty-eight reviews published between 1989 and 2023 met the inclusion criteria. Most were systematic reviews (n = 29, 76%). The number of primary studies included in reviews ranged between eight and 211. Prompting (n = 19, 50%) and pricing (n = 15, 40%) were the most assessed strategy type, either alone or in combination with another strategy. From the overview of reviews, pricing strategies appeared to be the most promising at improving consumer purchasing. Twenty-three high-quality primary studies met the inclusion criteria for further review. In most studies (n = 21, 91%), the goal was to increase sales of healthy products, most commonly fruit and vegetables, or products with a higher nutritional ranking. Only two studies (9%) aimed to exclusively reduce sales of unhealthy/less healthy products. Promotion was the most assessed strategy type (n = 11, 48%), either alone or in combination with another strategy. Common promotion strategies included providing education to customers about the health benefits of selected products, offering samples of products and giving food demonstrations. From the review of primary studies, promotional strategies used in combination with another strategy appeared to be most successful in the general population, and pricing was successful in subgroups of the population, including socioeconomically disadvantaged individuals, and those living in regional/remote areas. Overall, the evidence reviewed shows that the implementation of health-promoting supermarket interventions are more likely to be successful if they include a substantial pricing initiative (particularly for some subgroups), or the inclusion of promotion in combination with another strategy.

Burden of diabetic ketoacidosis among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

ObjectivesThis systematic review and meta-analysis aimed to assess the magnitude and determinants of diabetic ketoacidosis (DKA) among patients with diabetes mellitus (DM) in Ethiopia.DesignSystematic review and meta-analysis.ParticipantsAge 15 and above...

A methodological quality review of citations of randomized controlled trials of diabetes type2 in leading clinical practice guidelines and systematic reviews.

Evaluate methodological quality of type 2 diabetes RCTs conducted in Iran and cited in clinical practice guidelines and systematic reviews and meta-analyses. We conducted a descriptive methodological quality review, analyzing 286 Randomized Controlled Trials (RCTs) on diabetes mellitus published in Iran from July 2004 to 2021. We searched six databases systematically and evaluated eligible articles using the CONSORT 2010 checklist for abstracts. Two investigators assessed the data using a 17-item checklist derived from CONSORT. Additionally, we examined the citations of each RCT in 260 clinical practice guidelines, with a specific focus on the adequate reporting of outcomes. Out of 6667 articles, 286 analyzed. Poor reporting and failure to meet criteria observed. Only 3.8% cited in guidelines. Reporting rates: primary outcomes (41.9%), randomization (61.8%), trial recruitment (12.6%), blinding (50.8%). 27.9% cited in systematic reviews, 50.34% in systematic reviews and meta-analyses, 26.57% in meta-analyses. 67.8% of papers cited in systematic reviews. Adherence highest for participants, objective, randomization, intervention, outcome; lowest for recruitment, trial design, funding source, harms, and reporting primary outcomes. Poor methodological reporting and adherence to CONSORT checklist in evaluated RCTs, especially in methodological sections. Improvements needed for reliable and applicable results in guidelines, reviews, and meta-analyses. Inadequate outcome reporting challenges researchers, clinicians, and policymakers, impacting evidence-based decision-making. Urgent improvements in RCT registration necessary.

E-Cigarette Use and the Cessation of Tobacco Cigarette Smoking: Protocol for an Umbrella Review.

Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been examined in clinical studies for their effects on tobacco smoking cessation. In the past 2 years, a dozen or more systematic reviews on ENDS and cigarette smoking cessation have been published that present differing conclusions and recommendations on the use of ENDS. Our umbrella review aims to synthesize the findings from current systematic reviews to investigate the quit rates and the percentage of participants abstinent from cigarette smoking using ENDS. Additionally, we will examine the quit rates with ENDS in comparison to other established cessation treatments. The search will retrieve systematic reviews that include both clinical trials and experimental studies on the use of ENDS for smoking cessation. We will also include nonrandomized cohort studies that track ENDS use and the subsequent abstinence from smoking. Databases searches will be conducted in Embase, Scopus, PubMed, and 7 additional registries. Secondary searches will include reference checking, citation chasing, and consultations with topic experts. Two reviewers will perform a title and abstract exclusion followed by a full-paper inclusion process. Data extraction will be conducted by 1 reviewer and completely checked by a second reviewer. Each systematic review will be assessed by 2 reviewers for methodological quality using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews, version 2) and for reporting bias using categories from the Centre for Evidence-Based Medicine's Catalogue of Bias. Unreported discrepancies between the protocol and the published review will be identified. The umbrella review started on March 1, 2023. At the time of publication, the study selection was being conducted and the pilot testing of the data extraction and bias assessment forms were in progress. The review is expected to be completed by December 31, 2023, followed by the submission of the review for journal publication. A second-order meta-analysis will calculate the range and average of quit rates for ENDS. A vote counting of the direction of effect, based on quit rates, will be used to present the relative effectiveness of ENDS for smoking cessation compared to other cessation treatments (including no treatment). A citation matrix will list primary studies with their bias ratings from all the systematic reviews. The effect of overlapping studies between the systematic reviews will be calculated using the corrected coverage area analysis. A sensitivity analysis will examine the impact of the intensity of cessation treatment on quit rates. Depending on the availability of data, subgroup analyses will be conducted based on participants' gender, age, prior quit attempts, and nicotine dependence. The strength or weakness of the evidence synthesis will be assessed using a stratification of evidence technique. Reporting bias will be presented with a tabulation of bias indicators. Publication bias will be assessed. The use of ENDS for smoking cessation is a highly controversial subject. Through an exhaustive synthesis of the available data, we will present the quit rates of cigarette smoking cessation obtained with ENDS and how they compare to quit rates obtained from other established cessation treatments. The critical quality and bias assessment of the systematic reviews will indicate the most reliable sources to inform treatment considerations and policy development. PROSPERO CRD42023406165; https://tinyurl.com/4ekzpbrj. PRR1-10.2196/47711.

Is functional electrical stimulation effective in improving walking in adults with lower limb impairment due to an upper motor neuron lesion? An umbrella review.

To conduct an umbrella review of systematic reviews on functional electrical stimulation (FES) to improve walking in adults with an upper motor neuron lesion. Five electronic databases were searched, focusing on the effect of FES on walking. The methodological quality of reviews was evaluated using AMSTAR2 and certainty of evidence was established through the GRADE approach. The methodological quality of the 24 eligible reviews (stroke, n = 16; spinal cord injury (SCI), n = 5; multiple sclerosis (MS); n = 2; mixed population, n = 1) ranged from critically low to high. Stroke reviews concluded that FES improved walking speed through an orthotic (immediate) effect and had a therapeutic benefit (i.e., over time) compared to usual care (low certainty evidence). There was low-to-moderate certainty evidence that FES was no better or worse than an Ankle Foot Orthosis regarding walking speed post 6 months. MS reviews concluded that FES had an orthotic but no therapeutic effect on walking. SCI reviews concluded that FES with or without treadmill training improved speed but combined with an orthosis was no better than orthosis alone. FES may improve quality of life and reduce falls in MS and stroke populations. FES has orthotic and therapeutic benefits. Certainty of evidence was low-to-moderate, mostly due to high risk of bias, low sample sizes, and wide variation in outcome measures. Future trials must be of higher quality, use agreed outcome measures, including measures other than walking speed, and examine the effects of FES for adults with cerebral palsy, traumatic and acquired brain injury, and Parkinson's disease.

Reporting quality of abstracts from randomised controlled trials published in leading critical care nursing journals: a methodological quality review

ObjectivesTo evaluate the methodological quality of randomised controlled trial (RCT) abstracts in leading critical care nursing journals against the Consolidated Standards of Reporting Trials-s (CONSORT-A) checklist and to identify variables...

Effects of mobile technology-based interventions in promoting mental health and psychosocial wellbeing among young people in low-and middle-income countries: a systematic review protocol.

This review will aim to examine the effectiveness of mobile-based technologies among young people (10 to 24 years) in low- and middle-income countries in order to promote their mental health and psychosocial well-being. Such promotional interventions may be in the form of mobile technology-based education, information, or psychosocial counseling. Young people in low- and middle-income countries have limited access to mental health services. Mobile-based technologies, such as remote consultations, telehealth, and smartphone applications, can offer improved access to mental health services; however, to the best of our knowledge, there are no systematic reviews of effectiveness on this topic. Evidence sources from low- and middle-income countries involving mobile-based technologies for mental health and psychosocial support interventions for young people will be included. All experimental and observational studies published in English from 2010 to 2022 will be included. The review will follow JBI methodology for systematic reviews of effectiveness. Embase (Ovid), CINAHL (EBSCO), PsycINFO (ProQuest), AMED (Ovid), HMIC (Ovid) MEDLINE (PubMed), and Web of Science will be searched. Gray literature will be identified through Directory of Open Access Journals, ProQuest Dissertations and Theses, EThOs, Asia eHealth Information Network, Google Scholar, and Grey Literature Report. Retrieved articles will be screened against the inclusion criteria, followed by an assessment by 2 independent reviewers for methodological quality using standardized JBI appraisal tools. Data extraction will be done using standardized JBI data extraction tools. Narrative synthesis will be preferred if meta-analysis is not feasible and certainty of evidence will be assessed using the GRADE approach. PROSPERO CRD42022338749.

Reporting and methodological quality of systematic reviews of DPP-4 inhibitors for patients with type 2 diabetes mellitus: an evidence-based mapping.

To evaluate the reporting and methodological quality of relevant systematic reviews (SRs) and meta-analyses (MAs) onDipeptidyl peptidase-4 inhibitors (DPP-4I) forType 2 diabetes mellitus (T2DM). Relevant SRs and MAs on T2DM and DPP-4I published between 2017 and November 2021 were retrieved from PubMed, Embase, Cochrane Library, Web of Science, VIP, CNKI, CBM, and WanFang databases. Two independent reviewers performed the search, selection, and data extraction. The reporting and methodological quality of the reviewers was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) tools. The relationship between reporting and methodological quality score was assessed with the Spearman correlation test. Twenty-one studies involving 151,715 participants were included in the study. This overview showed that DPP-4I was safer and more efficacious than other anti-hyperglycemic drugs (OADs) in treating T2DM. The methodological quality of one SR was low, while the rest were very low. Thus, refinements are needed in the quality of protocol and registration information, a complete search strategy, the summary of the evidence, the listing of excluded studies, assessing the potential impact of risk of bias in RCTs, and discussing the RoB on MA results, and the funding of RCTs need improvement for generating SR. In addition, the reporting and methodological quality scores were moderately correlated (rS = 0.66, P = 0.001). DPP-4I is safer and more efficacious than OADs in treating T2DM. However, the reporting and methodological quality of the related SRs was unsatisfactory. Therefore, PRISMA and AMSTAR 2 analyses should be followed to enhance the overall quality of future SRs.

Devices measuring transepidermal water loss: A systematic review of measurement properties.

The objective of this review is to examine the reliability and measurement error of devices that measure transepidermal water loss (TEWL). TEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsiveness whereas measurement error scores in absolute terms the amount of error due to sources of variation. Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded. The search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias tool to assess the reliability and measurement error of outcome measurement instruments. A total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as 'Adequate' however reliability and measurement error statistical methods were on average rated as 'Doubtful'. TEWL measurement devices were found to demonstrate good reliability and frequently correlated with other devices. However, measurement error was highly variable but improves under in vitro conditions. Future research should consider risk of bias factors when designing studies.

Patients' and clinicians' experiences of remote consultation? Anarrative synthesis.

AimsTo identify, evaluate and summarize evidence of patient and clinician experiences of being involved in video or telephone consultations as a replacement for in‐person consultations.DesignNarrative synthesis.Data sourcesMedline; EMBASE; EMCARE; CINAHL and BNI. Searching took place from January 2021 to April 2021. Papers included were published between 2013 and 2020.Review MethodsPapers were appraised by two independent reviewers for methodological quality. Data extraction was conducted according to the standardized tool from Joanna Briggs Institute.ResultsSeven qualitative studies were included, from five countries and from the perspective of patients, relatives, administrators, nurses, physiotherapists and physicians. We developed two main themes: Pragmatic Concerns and Therapeutic Concerns. Each theme contained two categories: Pragmatic Concerns: (a) the convenience of non‐face to face consultations; (b) using technology and equipment in a consultation; Therapeutic Concerns (c) building therapeutic relationships; and (d) embracing benefits and addressing challenges.ConclusionThis narrative synthesis presents the existing evidence on clinician and patient experience of participating in non‐face to face consultations. Experiences are varied but largely focus on communication and forming relationships, using the technology successfully and the ability for patients to self‐manage with support from clinicians who are not in‐person. More high‐quality studies are required to explore the experiences of patients and clinicians accessing remote consultations as a result of global implementation post‐SARS‐CoV‐2 pandemic to identify any learning and education opportunities.ImpactHealth care staff can provide high‐quality care through video or telephone appointments as well as face to face appointments. This review has, however, identified that the evidence is limited and weak in this area and recommends there is research further to inform practice and influence future care.

814 Devices measuring transepidermal water loss of the skin: a systematic review of measurement properties

IntroductionTEWL is a physiological property of skin which increases when the epidermis is damaged. It is, therefore, a commonly utilised measure of skin barrier integrity. Devices measuring TEWL are available as open, semi-open or closed chamber. Studies of reliability examine the consistency of measurement, and/or responsive whereas measurement error scores in absolute terms the amount of error due to sources of variation.MethodsThe search strategy aimed to locate published and unpublished studies. Databases searched included PubMed, Embase, CINAHL and Web of Science, utilising identified keywords and limited to studies in English. Grey literature sources were searched to identify any unpublished documents. Study selection using the inclusion criteria was then assessed by two reviewers for methodological quality utilising the COSMIN risk of bias tool to assess the reliability and measurement error of outcome measurement instruments.Studies examining the reliability and/or measurement error of TEWL measurement devices were included. Studies that only report on measurement of TEWL outcomes without examination of reliability and/or measurement error were excluded.ResultsA total of 22 devices were examined in the 38 included studies. The quality of study design was on average rated as ‘Adequate’ however reliability and measurement error statistical methods were on average rated as ‘Doubtful’.ConclusionsTEWL measurement devices were found to demonstrate good reliability and often correlated with other devices. However, measurement error was highly variable but improves under in-vitro conditions.

Preconception exposures and adverse pregnancy, birth and postpartum outcomes: Umbrella review of systematic reviews.

Preconception exposures have been associated with adverse pregnancy, birth and postpartum outcomes. However, the reports, statements and guidelines of national and international health organisations vary in what they recommend individuals should monitor, avoid, reduce or practise in the preconception period. To synthesise and evaluate the evidence across systematic reviews for associations between exposures before conception and adverse pregnancy, birth and postpartum outcomes. MEDLINE, Embase, Epistemonikos (to May 2020) and reference lists of included reviews, without language or date restrictions. Systematic literature reviews of observational and/or interventional studies reporting associations between preconception exposures in women and/or men of reproductive age and pregnancy, birth or postpartum health outcomes were included. The methodological quality of reviews and the certainty of the evidence underlying each exposure-outcome association were assessed using AMSTAR 2 and the GRADE approach. We identified 53 eligible reviews reporting 205 unique exposure-outcome associations. Methodological quality was generally low with only two reviews rated as 'high' quality and two as 'moderate'. We found high-certainty, randomised trial evidence that maternal folate supplementation reduces the risk of neural tube defects and anomaly-related terminations. Moderate-certainty, observational evidence was found that maternal physical activity is associated with reduced risk of pre-eclampsia and gestational diabetes, and that paternal age of ≥40years and maternal body mass index (BMI) and interpregnancy weight gain are associated with increased risk of various adverse pregnancy and birth outcomes. Low- and very low-certainty evidence was found for other associations. Clinicians and policymakers can be confident that maternal folate supplementation should be encouraged during the preconception period. There is moderate certainty in the evidence base that maternal physical activity, BMI and interpregnancy weight gain and advanced paternal age are important preconception considerations. High-quality research is required to better understand other exposure-outcome associations.

Correctional nurse education and training to care for and support prisoners with dementia: a systematic review of text and opinion.

The objective of this review was to synthesize the best available evidence on the training required for correctional nurses to care for and support prisoners with dementia. Nurses caring for people in aged care facilities receive training related to aging and dementia; however, this has not carried across to training for the increasing aging population within correctional settings. Most research related to dementia care is focused on the aged and acute care sectors, and there is an absence of research in the correctional setting. Therefore, this systematic review was based on expert opinion and synthesizes information related to correctional nurse training for the support and care of prisoners with dementia. Articles focusing on correctional nurses, regardless of gender, who were responsible for the health care of adult prisoners were considered for this review. The primary phenomenon of interest was the training needs and requirements for correctional nurses to support prisoners with dementia. The secondary phenomenon of interest was how the delivery of the training could be facilitated. The context of this review was the adult correctional setting. The sources of information considered for this review included text and narratives describing expert opinion, expert opinion-based guidelines, expert consensus, published discussion papers, unpublished dissertations, reports accessed from professional organization websites, and government policy documents. A three-step search strategy was employed to look for both published and unpublished articles as recommended by JBI. The search was conducted for English-only articles, and from database inception to November 2020. All included articles were assessed by two independent reviewers for methodological quality. The data were extracted and pooled. Categories were developed and assigned based on similarity of meaning, and a set of synthesized conclusions was developed after subjecting the categories to meta-synthesis. Sixteen papers met the inclusion criteria and underwent critical appraisal and data extraction. Five synthesized findings were generated from 103 findings, which were aggregated into 15 categories. As expected, the rating was very low due to the nature of the included papers (ie, non-research), and the mix of unequivocal, credible, and unsupported findings. The review highlighted gaps in correctional nurse training related to caring for prisoners with dementia. Training for correctional nurses should incorporate information on general aging, alterations in aging, and dementia screening and management. Other findings included the need for policy and procedures related to training nurses to become dementia experts, and the development of partnerships with experts in the community to adapt training to the correctional setting.

Nurse leaders' experiences of upwards violence in the workplace: a qualitative systematic review.

The objective of this review was to synthesize the qualitative literature on the experience of upwards violence in nursing workplaces directed towards nurse leaders who have authority over those who direct the violence towards them. Workplace violence has impacted nursing work life for decades. It has been studied mostly from a downwards and lateral perspective and less often from an upwards direction towards individuals in leadership positions. Little is known about the experiences of nurse leaders or the potential consequences of workplace violence, including what impact upwards violence has on leadership ability and sustainability. This review considered qualitative studies that included nurse leaders who experienced upwards violence in nursing workplaces from nurses they supervise. Nurse leaders were registered nurses or advanced practice nurses employed in a position where they supervised other nursing personnel (eg, registered nurses, licensed practical nurses, nurse practitioners, student nurses). The positions held by nurse leaders included all roles (eg, nurse manager, clinical nurse specialist, nurse practitioner, nursing professor) where the position included supervising other nursing personnel. The search strategy aimed to find both published and unpublished studies in English from 2000. The search was first conducted in January 2019 and rerun in June 2020. The databases searched included CINAHL, MEDLINE, PsycINFO, and Embase. To ensure full coverage, databases not specific to the nursing profession, but with potential content on upwards violence, were also searched for examples of upwards violence against nurse leaders. These databases were ABI/INFORM, Sociological Abstracts, LexisNexis Academic, Scopus, and Web of Science. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, OpenGrey Repository, Health Business Elite, and Factiva. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality using the JBI critical appraisal checklist for qualitative research. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation. Six papers were included in the review yielding a total of 50 findings and nine categories. The categories were aggregated to form three synthesized findings: i) Physical, psychological, financial, and quality-of-work toll of upwards bullying: paying a high price; ii) Coping with violence alone; and iii) What happened to me? My take on the violence. The ConQual scores were low to moderate. The synthesized findings reveal that nurse leaders' experiences of upwards workplace violence is a troublesome problem that leads to a negative impact on physical and psychological health, and creates a cost in terms of time, money, and efficacy of the workplace.

Effectiveness of interventions to prevent falls for people with multiple sclerosis, Parkinson\u2019s disease and stroke: an umbrella review

BackgroundThe implementation of condition-specific falls prevention interventions is proving challenging due to lack of critical mass and resources. Given the similarities in falls risk factors across stroke, Parkinson’s Disease (PD) and Multiple Sclerosis (MS), the development of an intervention designed for groups comprising of people with these three neurological conditions may provide a pragmatic solution to these challenges. The aims of this umbrella review were to investigate the effectiveness of falls prevention interventions in MS, PD and stroke, and to identify the commonalities and differences between effective interventions for each condition to inform the development of an intervention for mixed neurological groups.MethodsA systematic literature search was conducted using 15 electronic databases, grey literature searches and hand-screening of reference lists. Systematic reviews of studies investigating the effects of falls prevention interventions in MS, PD and stroke were included. Methodological quality of reviews was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2. A matrix of evidence table was used to assess the degree of overlap. The Grading of Recommendations Assessments, Development and Evaluation framework was used to rate the quality of evidence. Findings were presented through narrative synthesis and a summary of evidence table.ResultsEighteen reviews were included; three investigating effectiveness of falls prevention interventions in MS, 11 in PD, three in stroke, and one in both PD and stroke. Exercise-based interventions were the most commonly investigated for all three conditions, but differences were identified in the content and delivery of these interventions. Low to moderate quality evidence was found for the effectiveness of exercise-based interventions at reducing falls in PD. Best available evidence suggests that exercise is effective at reducing falls in stroke but no evidence of effect was identified in MS.ConclusionsThe findings suggest that exercise-based interventions are effective at reducing falls in PD, however, the evidence for MS and stroke is less conclusive. A strong theoretical rationale remains for the use of exercise-based interventions to address modifiable physiological falls risk factors for people with MS, PD and stroke, supporting the feasibility of a mixed-diagnosis intervention. Given the high overlap and low methodological quality of primary studies, the focus should be on the development of high-quality trials investigating the effectiveness of falls prevention interventions, rather than the publication of further systematic reviews.

Review of NCOA Evidence Based Fall Prevention Strategies for the Home Health Setting

<h3>Objective(s)</h3> To evaluate the effectiveness of National Council on Aging (NCOA) evidence based fall prevention programs that can be completed in the home setting. <h3>Data Sources</h3> We conducted searches of PEDRo, CINAHL, PubMed and Scopus using combinations of the following search terms: fall prevention, community, intervention, exercise, physical therapy, evidence based, home. <h3>Study Selection</h3> Criteria were chosen to capture all studies that included NCOA fall prevention programs that can be implemented in the home setting. Inclusion criteria identified studies from peer-reviewed journals including NCOA fall prevention programs with elements allowing for individualized training and implementation. Studies with only community based, group provision were excluded. <h3>Data Extraction</h3> For articles included in this review, the following information was extracted: type of study, methodological quality review, level of evidence, number of subjects, outcome measures used, interventions, primary positive and negative results, and setting. <h3>Data Synthesis</h3> Four NCOA evidence based fall prevention programs were identified as appropriate to be provided in the home setting: CAPABLE, FallScape, FallsTalk and the Otago Exercise Program. Data extracted from included articles demonstrated improvements with falls efficacy, reduction in the number of falls, and increased recognition of fall risk. <h3>Conclusions</h3> Falls are a concern for older adults with expensive medical care and a loss of independence for the individual. With our analysis, 4 NCOA programs can be reasonably provided in the home setting. Only one program (CAPABLE) is specifically designed to be implemented in the home setting. While there is strong evidence of the effectiveness of these programs, more work is recommended to determine the best practices for provision of home programs. This work is relevant with the COVID-19 pandemic limiting community interventions. <h3>Author(s) Disclosures</h3> The authors declare no conflicts of interest.